Data analyses of angioplasty patients, whose operative and angioplasty (PTCA) interval was > or = 5 years, were performed to determine if the site of PTCA (coronary artery (CA) and/or vein bypass graft (VG)) influenced longevity. PTCA was successful in 677/768 lesions (88%) (377/432 CA (87%), and 294/327 VGs (90%)) and resulted in clinical improvement in 280/322 patients (87%). Patients were stratified into those who underwent PTCA of a lesion(s) in a coronary artery only, a vein graft only, or in both a coronary artery and a vein graft. Survival, at 60 months, was adversely affected (P < 0.05) for VG (59%) in comparison to CA (86%) or CA + VG (86%) cohorts, which was reaffirmed by a Cox proportional hazard model. PTCA was effective in opening lesions in coronary arteries or vein grafts in patients whose last bypass surgery had occurred over 5 years previously; however, PTCA patients who only had a vein graft had a significantly diminished 5-year survival in comparison to the cohorts, who had a coronary artery lesion dilated, with or without an accompanying vein graft PTCA. Therefore, PTCA of isolated vein graft lesions may not be the best long-term therapeutic option for these patients; however, it may best serve patients, acutely and long-term, who have an amenable significant arterial lesion, whether or not an accompanying vein graft lesion is dilated.