Prosthetic grafts are required for coronary artery bypass grafting (CABG) when the availability of suitable autologous conduits is limited. The ideal cardiovascular bypass graft requires a broad range of characteristics including strength, viscoelasticity, biocompatibility, blood compatibility and biostability. Many alternative conduits have been developed and used in the past, but most of them have failed, except in rare instances. This review aims to analyse the current status of their use and prospects for the future. We performed a literature search on PubMed using the generic terms 'conduits for coronary artery bypass grafting'; 'reoperative coronary artery bypass grafting'; 'redo coronary artery bypass grafting'; 'PTFE'; 'Dacron or PET'; 'gastroepiploic artery'; 'inferior epigastric artery'; 'biological grafts'; 'tissue-engineered grafts'; 'synthetic grafts'; 'prosthetic grafts'; 'polyurethane grafts'; 'cephalic veins'; 'short saphenous vein;' and 'alternative conduits'. In addition, we searched through related citations and references from selected articles. A total of 1253 references and 110 full-text articles were reviewed, and they were further selected based on available information. This review concludes that, over the past three to four decades, achieving the goal of a prosthetic graft with equivalent function and durability to the internal mammary artery or long saphenous vein has proved to be elusive.
Synthetic and to a lesser extent vein graft failure is still a major problem in the treatment of peripheral arterial disease, with neointimal hyperplasia being the main cause for graft occlusion in the medium and long term. This review aims to establish the current status of external stents or sheaths in the prevention of intimal hyperplasia in small diameter (< 6 mm) vein grafts.
Women undergoing elective AAA repair at National Health Service hospitals in England had increased short- and long-term mortality and post-operative morbidity compared with men. These findings can be used to improve pre-operative counselling for women undergoing AAA repair, and highlight the need for female-specific pre-, peri-, and post-operative management strategies.
This review found that there is insufficient high quality evidence to determine whether or not KL and TL GCS differ in their effectiveness in terms of reducing the incidence of deep vein thrombosis (DVT) in hospitalised patients. A major multicentre RCT is required to address this issue. In the meantime, the decision on which type of stocking to use in clinical practice is likely to be influenced by factors such as patient compliance, ease of use and cost implications.
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