The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial

Commentary: How does the vein look? Intraoperative storage strategy and vein graft disease prevention

“…A recent network meta-analysis suggested dual antiplatelet therapy rather than aspirin monotherapy was associated with reduced VGF without increase in major bleeding risk. 9 External vein graft stenting has been shown to slow progression of late VGD with high-resolution imaging, but this finding did not translate to reduced late graft failure and clinical outcomes were not assessed 10,11 ; clinical benefit may be elucidated by the ongoing larger VEST pivotal trial (NCT03209609), which incorporates major adverse cardiac and cerebrovascular events as a secondary outcome. Finally, harvest technique may be among the most important factors.…”

“…The no-touch harvest technique is associated with preserved histologic and endothelial function 8 and excellent patency, perhaps even approaching that of arterial grafts in the long term. [10][11][12] In summary, reasons for VGD are multifactorial. Potential for improvement in SVG occlusion rates into the single digits, as demonstrated in this trial, at 1 year seems feasible.…”

Reply from the authors: The race for the second best…continues—The no-touch saphenous vein versus the radial artery

“…Furthermore, when comparing the RA with the NT-SVG, we emphasize that the comparison must be performed on a level ground accounting for the known properties of the study conduits. To our knowledge, the study by Dreidfaldt and colleagues 3 is the only trial to compare the 2 conduits, and Samano and colleagues 6 used the NT-SVG almost exclusively for a number of years.…”

“…[12][13][14] In the trial by Dreifaldt and colleagues, 3 more than 60% of radial targets had less than 90% stenosis, with approximately 33% of the RAs targeted to a less than 70% stenotic vessel. 2,3 Furthermore, the media of the RA is 1.7-fold thicker than the internal thoracic artery, increasing its propensity for contractility. 15 Thus, it is encouraged to minimize alpha-adrenergic agents perioperatively if possible 16 and use calcium channel blockers (CCBs) at discharge for longitudinal protection.…”

“…16 A meta-analysis by Gaudino and colleagues 17 also showed that CCB therapy was protective against major adverse cardiac events (adjusted Cox hazard ratio 0.52, P ¼ .02) and further supported by the Society of Thoracic Surgeons practice guidelines that states it is reasonable to use RA grafts to targets with severe stenosis and pharmacotherapy to reduce perioperative graft spasm. 2,18 In the study by Dreifaldt and colleagues, 3 only 24% of patients received a CCB for the indication of hypertension. 2 Overall, Dreifaldt and colleagues 3 should be congratulated for undertaking a longitudinal RCT, which is a merit on its own.…”