Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery

• Percutaneous coronary intervention (PCI) after CABG surgery may be necessary in acute or chronic graft failure.
• PCI after early graft failure is a valuable option to treat postoperative myocardial infarction.
• PCI on degenerated saphenous vein graft is often associated with poor angiographic and clinical outcome and requires focused approach.
• Hybrid coronary revascularization combines the advantages of the two techniques and is a valuable option in selected patients.

Repeat myocardial revascularization procedures are markedly different from de novo interventions, with increased procedural risk and technical-demanding complexity.However the number of patients previously treated with coronary artery bypass graft (CABG) that need a repeat revascularization due to graft failure is increasing consistently. Late graft failure, usually caused by saphenous vein grafts (SVG) attrition, is certainly not uncommon. However PCI on degenerated SVG presents higher complication rate and worse clinical outcome compared with native arteries interventions.In acute graft failure setting, PCI represents a valuable option to treat postoperative myocardial infarction.