Percutaneous interventions on arterial conduits.

Because of the extensive use of arterial conduits for coronary surgery and the increased risk of repeat surgery in cases of graft failure, there is a growing interest in percutaneous interventions (PI) for patients with conduit dysfunction. PI on arterial conduits is a challenge for the interventional cardiologist, due to anatomic and functional characteristics of the graft. There are no large-scale multicenter or randomized studies focusing on PI of arterial conduits. Few single-center experiences are available, and all report short-term encouraging results and < 20% restenosis rates. Procedural failures are mainly due to graft tortuosity or length. Spasm is not rarely reported in muscular conduits. Stents are effective for the treatment of ostial disease and in bail-out cases, but should be cautiously used in anastomotic lesions. In patients with patent internal mammary artery, large pectoralis branches are sometimes considered responsible for steal phenomena, but flow diversion is usually trivial and embolization should be accomplished only after careful functional evaluations. PI can safely be performed on arterial grafts, with careful planning and knowledge of conduit pathophysiology.