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How I Deal With... SVGs

This document explores advanced techniques for managing saphenous vein grafts (SVGs) in patients with critical limb ischemia and acute coronary syndromes. It outlines the use of laser catheters, saline infusion protocols, and critical interventions in complex cases, illustrated with real patient scenarios. Key points include the essential saline flushing protocol during laser activation to optimize contact with the lesion, as well as details on patient demographics, medical history, and procedural outcomes. Designed for healthcare professionals, this summary serves as a resource for enhancing procedural techniques in SVG management.

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How I Deal With... SVGs

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  1. How I Deal With...SVGs Simon Redwood St Thomas’

  2. No Conflict of Interest to Declare

  3. Mr PM, 55 years old • CABG 1993 • SVG – LAD • SVG – OM2 • 8F LCB

  4. How should we tackle this?

  5. Laser Catheter 0.9, 1.4. 1.7. 2.0 mm diameter

  6. Particle Size post 308 nm ablation 5% : > 5 - <12 micron 50% : < 1 micron 45% : 1 – 5 micron Erytrocyte = 7µ

  7. Saline Infusion Protocol In order to obtain an optimal contact between catheter tip and lesion it is mandatory to implement the saline infusion protocol. 15-20 ml saline bolus after each contrast injection 15-20 ml saline flush during every laseractivation (5 sec)

  8. Saline Infusion Images taken from the DVD: Critical Limb Ischemia, New Techniques For Complex Interventions, Prof. Dr. Giancarlo Biamino - Dr. Dierk Scheinert (Herzzentrum Leipzig) Michael Jaff, MD (Lennox Hill, NY)

  9. Luge • 2.0c laser

  10. 5x28 to mid lesion • 5.0x20 proximal • 5.0x15 Quantum

  11. Peak CK 194

  12. Mr JN, 64 years old • CABG 1988 • LIMA – LAD • SVG – RCA and “LCx” • Tn +ve ACS • Anterolat ST changes • LIMA – LAD normal • SVG – RCA occluded

  13. Continued pain with ECG changes • BP 80 systolic

  14. 8F HS • IABP • Luge

  15. 2.0c laser

  16. Filterwire

  17. 4.0x20 distal • 4.0x28 prox • 4.0 post dilatation

  18. Peak CK 14

  19. Mrs DC, 72 years old • CABG 1999 • LIMA-LAD • SVG-OM1 and RCA • Tn +ve ACS (>2) • Infero-lat ST depression

  20. Luge • 2.0c laser

  21. Filterwire • 4.5x28 distal

  22. 4.5x24 prox Peak CK 205

  23. Summary Conventional wire Debulk with laser Filter device Stent – usually BMS, occ. covered

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