Impact of the size mismatch between saphenous vein graft and coronary artery on graft patency

Yamane, Yasuo; Uchida, Naoshige; Okubo, Shuhei; Morimoto, Hironobu; Mukai, Shogo

doi:10.1007/s11748-016-0694-4

Cited by 19 publications

(12 citation statements)

References 19 publications

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“…19 A previous study reports that mismatches with diameter ratios <2.8 affected SVG patency rates and the authors diagnosed a three-year patency rate of 86.1%. 10 In our study, mismatches were detected in four patients based on a diameter ratio cut-off value of < 2.8. However, a meta-analysis shows that SVG patency rates were similar (82.3%) at 2.6 years for all SVGs, irrespective of size mismatches to the native artery.…”

Section: Intra-operative Graft Assessmentmentioning

confidence: 60%

“…If there was a visual suspicion of a size mismatch between the graft and native coronary artery, the diameter ratio was calculated by dividing the graft diameter by the coronary artery diameter, and a value >2.8 was considered a size mismatch. 10 All of the grafts were assessed by using transit-time flow measurement (TTFMs) after angiography and attaching all proximal anastomoses.…”

Section: Methodsmentioning

confidence: 99%

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Intraoperative angiography during coronary artery bypass grafting

et al. 2021

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Introduction: The aim of this study was to evaluate the incidence rate of technical failure of graft patency while performing intra-operative angiography after coronary artery bypass grafting. Methods: This prospective pilot study included 50 patients with multi-vessel coronary artery disease who underwent coronary artery bypass grafting, in addition to intra-operative angiographic graft assessments, on open-chest. Overall, 144 grafts and 160 distal anastomoses were assessed in a hybrid operating room. Results: Intra-operative angiography allowed the identification of 23 angiographic defects (15.9% of all grafts) in 22 patients (44%): three graft defects (2% of all grafts), 17 anastomotic defects (10.6% of all distal anastomoses), and three target artery errors (1.8% of all grafted arteries). Ten re-interventions (43.4%) were performed based on the angiographic defects detected. During the follow-up period, computed tomography angiography of the attached grafts at a mean of 224 days (range, 80–318 days) showed that all repaired grafts were patent. During surgery, the total mean dose of radiation was 1.848 ± 0.54 mSv (range, 0.78–3.4 mSv) per patient and investigation time was 19.4 ± 4.94 minute (range, 9–31 minute). Conclusions: Intra-operative angiography is a powerful tool allowing the identification of graft defects, anastomotic defects and target vessel errors. Assuming relatively low level of exposure to radiation and short investigation time, intra-operative angiography could be included in routine practice as safe procedure improving surgery quality.

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Section: Intra-operative Graft Assessmentmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Intraoperative angiography during coronary artery bypass grafting

et al. 2021

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“…Studies have shown that when an SVG is grafted to the right coronary artery, the long-term patency rate is relatively favorable when the SVG–right coronary artery diameter ratio is ≤2.8. 18,19 In the 2016 ORACLE-NIRS study by Danek et al., 20 intravascular ultrasound and optical coherence tomography were used to evaluate SVG outcomes. The study showed that older SVGs were associated with a higher lipid core burden index and smaller lumen area and diameter, which significantly affected the long-term patency of the SVG.…”

Section: Risk Factors For Svgdmentioning

confidence: 99%

Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting

Gao

Yin

2018

J Int Med Res

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Saphenous vein graft disease (SVGD) is a type of vascular disease that may develop after coronary artery bypass grafting (CABG). SVGD seriously affects the short-term and long-term effects of CABG and increases the incidence of major adverse cardiovascular events. It is very important to identify patients at greatest risk and carry out prevention and treatment measures to determine the risk factors for SVGD. Many factors contribute to SVGD when the vein is grafted into an arterial environment, such as surgery-related factors, smoking, diabetes mellitus, hyperlipidemia, and others. In this review, we discuss the risk factors for SVGD, current surgical and pharmacologic therapies with which to manage SVGD, and the prevention of SVGD.

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“…Regarding flow dynamics, the current understanding based on computational fluid dynamics indicates that geometric factors including anastomotic angle, shape of the distal anastomosis, and the graft-to-coronary artery diameter ratio affect graft patency 8,9) . In particular, flow turbulence resulted from the discrepancy between the graft and coronary diameter, may cause abnormal wall shear stress, which initiates intimal thickening, and resulted in graft occlusion [9][10][11] . This technique is especially artery (LITA) was used for 57 anastomoses, the right internal thoracic artery (RITA) was used for 10, RGEA was used for 4, and the radial artery was used for 1.…”

Section: Techniquementioning

confidence: 99%

Side-to-side Anastomosis Technique using Four Interrupted Sutures for Sequential Grafting with an Arterial Graft

2017

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Objective: Sequential grafting using an arterial graft is essential for achieving complete revascularization and long-term patency with complex multivessel diseases; however, technical difficulties still exist. Side-to-side anastomosis using 4 interrupted sutures for sequential grafting is effective for implementing complete revascularization for such complex coronary lesions. In this study, we evaluated the effectiveness of this technique for small coronary arteries using arterial grafts. Materials and Methods: Between March 2010 and March 2017, the side-to-side technique with 4 interrupted sutures and arterial grafts for targeting small coronary arteries, smaller than 1.0 mm in diameter, was performed for 72 sequential anastomoses (69 for proximal touchdown site of sequential graft and 3 for distal) in 68 patients (57 men and 11 women; mean age, 64.4 ± 9.0 years). Results: This technique was frequently used for the proximal portion of the left internal thoracic artery (LITA)-diagonal branch(D)-left anterior descending coronary artery (35 anastomoses; 49%), LITA-D/circumflex coronary artery (Cx)-Cx (19 anastomoses; 26%) sequential grafting. Postoperative coronary angiography was performed for 65 of 72 anastomoses (90%). Fitz-Gibbon grade A was found for 64 of 65 (98%), grade B was found for 1 of 65 (2%), and grade O was not observed. Conclusion: The side-to-side anastomosis technique with 4 interrupted sutures and arterial grafts for small coronary arteries is versatile, safe, and associated with excellent short-term outcomes.

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Impact of the size mismatch between saphenous vein graft and coronary artery on graft patency

Abstract: A mismatch between SVG diameter and RCA diameter has an impact on the patency rate of the SVG. Evaluation of the saphenous vein before surgery and selection of a graft to minimize mismatch should improve SVG patency.

Cited by 19 publications

References 19 publications

Intraoperative angiography during coronary artery bypass grafting

Intraoperative angiography during coronary artery bypass grafting

Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting

Side-to-side Anastomosis Technique using Four Interrupted Sutures for Sequential Grafting with an Arterial Graft

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