The Effect of External Stenting for Saphenous Vein Grafts on Early Postoperative Patency

Background: External stenting (ExSt) on saphenous veins was designed to improve graft patency in patients undergoing CABG surgery. Indeed, some experimental and descriptive small studies have shown an advantage of external stenting. However, reluctance to the usage of such stents persists. In this study, we aim to show the improved perioperative graft patency of saphenous veins using an ExSt (VEST, Vascular Graft Solutions, Tel Aviv) employing postoperative computed tomography coronary angiography.

Method: Data from consecutive patients were collected between 2018 and 2021 from patients undergoing isolated CABG with at least one SVG graft. Cardiac computed tomography performed routinely prior to discharge was available for all patients. Logistic regression analyses were performed to compare graft patency estimates between the stented and nonstented groups, at both the patient and the graft level, with age, EuroSCORE II, gender, diabetes, and several arterial grafts as covariates. Additional subgroup analysis according to the different covariates was performed.

Results: We identified 357 patients who matched the inclusion criteria. There were 572 graft veins in total. 150 patients (205 SVGs) received ExSt versus 207 patients (337 SVGs) without ExSt. The probability of overall SVG patency at discharge was higher in the stented group compared with the nonstented group, at both graft (93.5 vs. 87.3%, odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.0–4.4; p = 0.06) and patient level (89.6 vs. 82.9%, OR: 1.8; 95% CI, 0.9–3.6; p = 0.1). Of note, the difference between stented and nonstented groups was most significant in the subgroup receiving two arterial grafts (96.4 vs. 89.3%, OR: 3.2; 95% CI, 1.2–8.4; p = 0.02), and in the subgroup with higher (median > 1.1) EuroSCORE II (98.4 vs. 88%, OR: 8.7; 95% CI, 1.1–71.3; p = 0.04).

Conclusion: This study is one of the most extensive studies analyzing early postoperative graft patency of ExSt SVG using computed tomography coronary angiography. Indeed, in our study, we showed an improved perioperative SVG patency using ExSt. Moreover, high-risk patients and patients getting at least two arterial grafts appear to have an advantage using ExSt of SVG.

Publication History

Article published online:
28 January 2023