Saphenous vein graft shrinkage as a mechanism of stenosis soon after bypass surgery.

A 63-year-old man with left main coronary artery disease underwent aortocoronary bypass surgery using saphenous vein grafts. Less than 1 month later, severe narrowing occurred in the mid-portion of the vein graft to the left anterior descending coronary artery. Preintervention intravascular ultrasonography revealed prominent vein graft shrinkage. Percutaneous transluminal angioplasty failed because the stenotic lesion could not be dilated, even by high-pressure balloon inflation. Saphenous vein graft shrinkage appears to be one of the mechanisms of early saphenous vein graft stenosis, and balloon angioplasty to the vein graft stenosis with prominent shrinkage may be of only limited value.