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Post-CABG Thrombosis
Darragh Brady, MD; Gerard M. Healy, MD; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Coronary artery bypass graft (CABG)
          • Definitions

            • Saphenous vein graft failure due to subtotal or total occlusive thrombosis
              • Thrombosis, intimal hyperplasia, and accelerated atherosclerosis contribute to graft failure in acute, subacute, and late postoperative periods, respectively
              • In early (< 1 month) postoperative period, acute thrombosis is dominant etiology
                • Technical failure may contribute

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Hillis LD et al: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 124(23):2610-42, 2011. Erratum in: Circulation. 124(25):e956, 2011. Circulation. 126(7):e105, 2012
                                        2. Brilakis ES et al: Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial. Lancet. 391(10134):1997-2007, 2018
                                        3. Zhao Q et al: Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: A randomized clinical trial. JAMA. 319(16):1677-86, 2018
                                        4. Lee M et al: Current state of the art in approaches to saphenous vein graft interventions. Interv Cardiol. 12(2):85-91, 2017
                                        5. McKavanagh P et al: Management and prevention of saphenous vein graft failure: A review. Cardiol Ther. 6(2):203-23, 2017
                                        6. Chan M et al: A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 221:898-905, 2016
                                        7. Gluckman TJ et al: Effects of aspirin responsiveness and platelet reactivity on early vein graft thrombosis after coronary artery bypass graft surgery. J Am Coll Cardiol. 57(9):1069-77, 2011
                                        8. Parang P et al: Coronary vein graft disease: pathogenesis and prevention. Can J Cardiol. 25(2):e57-62, 2009
                                        9. Ropers D et al: Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation. Circulation. 114(22):2334-41; quiz 2334, 2006
                                        10. Frazier AA et al: Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 25(4):881-96, 2005
                                        11. Enzweiler CN et al: Diameter changes of occluded venous coronary artery bypass grafts in electron beam tomography: preliminary findings. Eur J Cardiothorac Surg. 23(3):347-53, 2003
                                        12. Stone GW et al: Prospective, randomized evaluation of thrombectomy prior to percutaneous intervention in diseased saphenous vein grafts and thrombus-containing coronary arteries. J Am Coll Cardiol. 42(11):2007-13, 2003
                                        13. Shuhaiber JH et al: Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg. 22(3):387-96, 2002
                                        14. Fitzgibbon GM et al: Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 28(3):616-26, 1996
                                        15. Mak KH et al: Subacute stent thrombosis: evolving issues and current concepts. J Am Coll Cardiol. 27(2):494-503, 1996
                                        16. Walts AE et al: Thrombosed, ruptured atheromatous plaques in saphenous vein coronary artery bypass grafts: ten years' experience. Am Heart J. 114(4 Pt 1):718-23, 1987
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Coronary artery bypass graft (CABG)
                                                • Definitions

                                                  • Saphenous vein graft failure due to subtotal or total occlusive thrombosis
                                                    • Thrombosis, intimal hyperplasia, and accelerated atherosclerosis contribute to graft failure in acute, subacute, and late postoperative periods, respectively
                                                    • In early (< 1 month) postoperative period, acute thrombosis is dominant etiology
                                                      • Technical failure may contribute

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Hillis LD et al: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 124(23):2610-42, 2011. Erratum in: Circulation. 124(25):e956, 2011. Circulation. 126(7):e105, 2012
                                                                              2. Brilakis ES et al: Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial. Lancet. 391(10134):1997-2007, 2018
                                                                              3. Zhao Q et al: Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: A randomized clinical trial. JAMA. 319(16):1677-86, 2018
                                                                              4. Lee M et al: Current state of the art in approaches to saphenous vein graft interventions. Interv Cardiol. 12(2):85-91, 2017
                                                                              5. McKavanagh P et al: Management and prevention of saphenous vein graft failure: A review. Cardiol Ther. 6(2):203-23, 2017
                                                                              6. Chan M et al: A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 221:898-905, 2016
                                                                              7. Gluckman TJ et al: Effects of aspirin responsiveness and platelet reactivity on early vein graft thrombosis after coronary artery bypass graft surgery. J Am Coll Cardiol. 57(9):1069-77, 2011
                                                                              8. Parang P et al: Coronary vein graft disease: pathogenesis and prevention. Can J Cardiol. 25(2):e57-62, 2009
                                                                              9. Ropers D et al: Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation. Circulation. 114(22):2334-41; quiz 2334, 2006
                                                                              10. Frazier AA et al: Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 25(4):881-96, 2005
                                                                              11. Enzweiler CN et al: Diameter changes of occluded venous coronary artery bypass grafts in electron beam tomography: preliminary findings. Eur J Cardiothorac Surg. 23(3):347-53, 2003
                                                                              12. Stone GW et al: Prospective, randomized evaluation of thrombectomy prior to percutaneous intervention in diseased saphenous vein grafts and thrombus-containing coronary arteries. J Am Coll Cardiol. 42(11):2007-13, 2003
                                                                              13. Shuhaiber JH et al: Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg. 22(3):387-96, 2002
                                                                              14. Fitzgibbon GM et al: Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 28(3):616-26, 1996
                                                                              15. Mak KH et al: Subacute stent thrombosis: evolving issues and current concepts. J Am Coll Cardiol. 27(2):494-503, 1996
                                                                              16. Walts AE et al: Thrombosed, ruptured atheromatous plaques in saphenous vein coronary artery bypass grafts: ten years' experience. Am Heart J. 114(4 Pt 1):718-23, 1987