Recurrence of Symptoms After Coronary Artery Bypass Surgery Patients with prior bypass surgery who develop postoperative angina represent an important subset of patients who require thoughtful evaluation and therapy. Arterial conduits often provide long-term patency over at least 15 years. Saphenous vein grafts are more vulnerable to graft atherosclerosis and subsequent closure.
Postoperative angina is an increasing problem.
Catheter-based techniques are attractive as an alternative to the high risk of reoperation but are not without risk, especially when performed in an older vein graft. Long-term survival of this cohort was compared with a similar surgically treated group. One randomized controlled study has evaluated the role of stent placement in saphenous vein graft disease. Coronary angiography is reasonable in patients who are symptomatic within the first 12 months after bypass surgery, because relatively low-risk revascularization by percutaneous techniques can often be offered. Angiography should be avoided in postbypass patients who, by virtue of age or other comorbidity, are poor candidates for repeat revascularization by either reoperation or angioplasty.