External stenting for saphenous vein grafts in coronary artery bypass grafting: A meta‐analysis

Abstract

ObjectivesAutologous saphenous vein grafts (SVGs) are the most commonly used bypass conduits in coronary artery bypass grafting (CABG) with multivessel coronary artery disease. Although external support devices for SVGs have shown promising outcomes, the overall efficacy and safety remains controversial. We aimed to evaluate external stenting for SVGs in CABG versus non‐stented SVGs.MethodsMEDLINE, EMBASE, Cochrane Library and clinicaltrails.gov were searched for randomized controlled trials (RCTs) to evaluate external‐stented SVGs versus non‐stented SVGs in CABG up to 31 August 2022. The risk ratio and mean difference with 95% confidence interval were analysed. The primary efficacy outcomes included intimal hyperplasia area and thickness. The secondary efficacy outcomes were graft failure (≥50% stenosis) and lumen diameter uniformity.ResultsWe pooled 438 patients from three RCTs. The external stented SVGs group showed significant reductions in intimal hyperplasia area (MD: −0.78, p < 0.001, I2 = 0%) and thickness (MD: −0.06, p < 0.001, I2 = 0%) compared to the non‐stented SVGs group. Meanwhile, external support devices improved lumen uniformity with Fitzgibbon I classification (risk ratio (RR):1.1595, p = 0.05, I2 = 0%). SVG failure rates were not increased in the external stented SVGs group during the short follow‐up period (RR: 1.14, p = 0.38, I2 = 0%). Furthermore, the incidences of mortality and major cardiac and cerebrovascular events were consistent with previous reports.ConclusionsExternal support devices for SVGs significantly reduced the intimal hyperplasia area and thickness, and improved the lumen uniformity, assessed with the Fitzgibbon I classification. Meanwhile, they did not increase the overall SVG failure rate.

External Support of Autologous Internal Jugular Vein Grafts with FRAME Mesh in a Porcine Carotid Artery Model

“…A follow-up of 4.5 years ("the VEST IV trial") has been reported in 21 patients from the VEST I trial; external stenting significantly reduced diffuse intimal hyperplasia and the development of lumen irregularities; however, graft failure rates were still comparable between stented and non-stented groups [63]. Other meta-analyses [64,65] and a review [13] have reported similar conclusions. Larger trials with longer follow-ups are warranted to determine whether the positive remodeling effects might translate into clinical benefits [6,9].…”

Consensus statement—graft treatment in cardiovascular bypass graft surgery

“…Next, overdistending the vein conduits with supra-physiological pressures to check for leaks or to increase the lumen of the veins should be abandoned from clinical practice. However, it has to be acknowledged that currently, the utilization of, yet cost-intensive, pressure-controlled syringes in large parts of the world pose an important economical burden ( 129 ).…”

The Controversy of Using Insufficient Great Saphenous Veins in Coronary Artery Bypass Grafting: A Comparative Morphological Analysis of Healthy and Insufficient Veins Related to the Possibility of Using Them as a Graft

“…In such cases, where the trajectory suggests potential vein graft stenosis or failure, an additional graft stenting procedure becomes a necessity. This intervention aims to mitigate the intimal hyperplasia area and thickness, enhancing lumen uniformity—an aspect assessed with the Fitzgibbon I classification [ 26 ]. The meticulous consideration of these factors, grounded in the insights from our morphological analysis, emphasizes the intricate balance between the structural attributes of veins and their long-term functionality as conduits in CABG.…”