Chapter 36: Transradial Interventions in Saphenous Vein Grafts

According to the American College of Cardiology National Cardiovascular Data Registry, there were over 90,000 patients (5.7% of all PCIs) who underwent saphenous vein graft (SVG) percutaneous coronary intervention (PCI) between 2004 and 2009. Years ago, SVG PCI via the radial approach was thought to be a relative contraindication. In the contemporary era, the transradial approach for SVG PCI is shown to be feasible, as quick as the femoral approach, and is associated with fewer vascular complications and shorter length of stay.

With appropriate planning and skill, SVG PCI can be performed as easily via the transradial approach as via the transfemoral approach.

Anatomic Considerations

A review of the patient’s anatomy based on diagnostic angiography allows for an appreciation of any tortuosity in the aorta and/or subclavian and innominate artery, tortuosity within the graft as well as the location, and angle of the vein graft’s origin. Lesion specific characteristics, including thrombus, calcification, ostial location, and vessel diameter, remain considerations as with any PCI.

Author: 
Duane S. Pinto, MD, MPH, FACC, FSCAI and Shamail S. Tariq, MD, MBA