Long-term follow-up of patients after coronary artery bypass graft (CABG) surgery has shown that angina may eventually recur in up to 8" of patients annually due to graft stenoses or occlusions or progression of disease within the native coronary arteries. Patients with recurrent angina pectoris after CABG surgery may be suitable for PCI to their grafts or native coronary arteries as an alternative to medical treatment or repeat CABG surgery. The choice depends on many factors including age, coexisting medical conditions, left ventricular function, availability of conduits, the risk of damaging functioning grafts and the likelihood of a successful reoperation. Lipid deposition and atherosclerotic plaque may start developing in areas of intimal hyperplasia at 12-18 months causing a late occlusion. Beyond 5 years, complex vein graft lesions with eccentric, ulcerated atheromatous stenoses and friable thrombotic material are more frequently encountered as well as diffuse disease and graft occlusion.
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