[HSF] Image of the week: radial graft failure

[Tea Acuff]

Trying to think further about your question: 

Part of the problem with what we see is how we conceive what we see (our staging of "reality" TV). For example we tend to think of CAD as static obstructions. Thus we expect changes to what we do but not to what we don't do on followup. We intellectually know that this is not the case, yet tend to reduce the problem to this static view. If we start thinking about the patient specifics, "active young disease", calcific old, etc, we might find we do things better by this thinking and resorting than by procedural or static disease CABG thinking. Or what if we treated all aortic valve disease as procedural AVR instead of for endocarditis, aortic dissection, biscuspid, senile degeneration? We clearly do both, global AVR series and subset contrasts, but which do we think of as better science (=discrimination)?

tea




________________________________
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: open heart list <openheart-l at lists.hsforum.com>
Sent: Tuesday, August 4, 2009 10:58:16 AM
Subject: RE: [HSF] Image of the week: radial graft failure


the high lateral had never been intervened on previously - surgically or percutaneously - and had mild stenosis prior to CABG . 



Now you are making me think deeper - I had never thought of ascribing blame for the progression of native disease to my surgery. Maybe there is validity to that, afterall few months ago Don was blaming medical therapy for the failure of his by-pass grafts....certainly maybe both are related to surgery, but how?



ani

> Date: Tue, 4 Aug 2009 08:33:38 -0700
> From: tacuff at swbell.net
> Subject: Re: [HSF] Image of the week: radial graft failure
> To: OpenHeart-L at lists.hsforum.com
> CC: 
> 
> 
> Was the 30% lesion in the lateral before or after DES treatment? If after, that is the 30% is restenosis, then your question implies an odd aysmmetry. Okay not odd as the question is typical, but asymmetrical none the less. Why is the problem with the radial related to you and the lateral not? Do we get to assign different blames after the fact? Is bad science good practice?
> Tea 
> 
> Sent from my iPhone
> 
> On Aug 4, 2009, at 9:28 AM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
> 
> 
> Case from early 2009: 43y male with aggresive CAD, multiple prior stents since 2004. I did arterial OPCAB which included free radial to PDA. Two months later had angina. Cardiac cath showed he had now 95% lesion in a high lateral which had been previously been <30% stenosed (treated with DES). Also has stenosis in mid aspect of radial graft (below) which was treated with DES with good immediate result. IMA grafts were pristine.
> 
> 
> 
> Why would a radial graft have such discrete stenosis and luminal irregularities only several weeks later? Of course we would like to blame the patient but lets assume the more likely scenario that this was a technical failure. Possible causes and prevention (other than using vein grafts!). Conduit was harvested open using skeletonization with combination of low energy cautery and sharp dissection.
> 
> 
> 
> Thanks
> 
> 
> 
> Ani
> 
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