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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg

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Symptomatic late saphenous vein graft failure in coronary artery bypass surgery

Mikael Janiec1,2, Axel Dimberg3, Rickard P F Lindblom1,2

  • 1Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden.

Interdisciplinary Cardiovascular and Thoracic Surgery
|April 4, 2023
PubMed

Insights

Late saphenous vein graft (SVG) failure contributes minimally to poor outcomes in coronary artery bypass grafting. This study estimates the risk of symptomatic SVG failure, suggesting limited room for improvement with alternative grafts.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Grafting
  • Coronary Artery Disease Management

Background:

  • Coronary artery bypass grafting (CABG) using saphenous vein grafts (SVGs) is standard for advanced coronary artery disease.
  • Long-term SVG performance and its impact on clinical outcomes remain incompletely understood.
  • The potential for improved patient results with alternative graft materials is an area of ongoing research.

Purpose of the Study:

  • To estimate the contribution of late saphenous vein graft failure to long-term outcomes after coronary artery bypass grafting.
  • To quantify the risk of symptomatic SVG failure over a 10-year period post-surgery.
  • To provide an upper limit for potential improvements achievable by using superior graft alternatives.

Main Methods:

  • Retrospective analysis of 44,951 patients undergoing CABG between 1997 and 2020.
  • Data extracted from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease registry.
  • Inclusion criteria: internal thoracic artery graft with single distal anastomosis and 1, 2, or 3 distal SVG anastomoses; collection of postoperative angiography and graft status data.

Main Results:

  • Clinically driven angiography rates within 10 years post-surgery were 23.6%, 20.0%, and 17.5% for patients with 1, 2, or 3 SVG anastomoses, respectively.
  • Excluding the initial 3 postoperative years, over 75%, 60%, and 45% of SVGs remained patent at 10-year angiography for patients with 1, 2, or 3 distal anastomoses, respectively.
  • The rate of failed SVGs after the first 3 years was low across all groups.

Conclusions:

  • The risk of symptomatic graft failure due to vein graft disease is estimated at 1-2% per grafted coronary vessel within the first 10 years.
  • These findings suggest limited potential for substantial improvement by replacing SVGs with alternative conduits.
  • The study provides a benchmark for evaluating the efficacy of novel SVG alternatives in CABG.
Abstract

Keywords:
Coronary artery bypass graftingGraft failure

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