Saphenous vein graft perforation during percutaneous coronary intervention: a case series

J Invasive Cardiol. 2013 Mar;25(3):157-61.


Introduction: The outcomes of perforation during aortocoronary saphenous vein graft (SVG) percutaneous coronary intervention (PCI) are poorly studied.

Methods: We reviewed all 12 SVG perforations that occurred between November 2005 and November 2011 at two tertiary referral centers. The acute and long-term outcomes of these patients were examined.

Results: The perforation was located in the SVG body (n = 6), aortic (n = 3), or distal (n = 3) anastomosis. Most perforations occurred after stent implantation (n = 5) or after stent postdilation (n = 3). The perforation was Ellis class I in 1 patient, II in 3 patients, III in 4 patients, and III with cavity spilling in 3 patients. The perforation spontaneously sealed without requiring further treatment in 3 patients. In the remaining 9 patients, the perforation was treated with prolonged balloon inflation (n = 2) or covered stent implantation (n = 5), but could not be treated in 2 patients who died during the procedure. Seven of the 10 survivors underwent follow-up angiography 5 months to 2 years after the perforation. The target SVG was occluded in 5 patients and had developed severe stenosis in the remaining 2 patients.

Conclusions: SVG perforation during PCI carries a high mortality and frequently requires implantation of a covered stent. Perforated SVGs frequently occlude within 2 years post PCI.

MeSH terms

  • Acute Coronary Syndrome / therapy*
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary
  • Coronary Angiography
  • Coronary Artery Bypass*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / surgery*
  • Percutaneous Coronary Intervention / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Rupture / epidemiology
  • Saphenous Vein / injuries*
  • Saphenous Vein / transplantation
  • Stents
  • Treatment Outcome