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Updated: Jan 7, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Propensity-matched analysis of the impact of saphenous vein graft external stenting on clinical outcomes in coronary
Luca P Weltert1, Eric A Secemsky2,3, Gil Bolotin4
1Department of Cardiac Surgery, European Hospital, Rome, Italy.
Insights
External saphenous vein graft stenting significantly reduces adverse clinical outcomes up to 5 years after coronary artery bypass grafting (CABG). This intervention lowers major adverse cardiovascular events and target vessel revascularization rates compared to standard care.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- External saphenous vein graft stenting is a technique used after coronary artery bypass grafting (CABG).
- It aims to reduce intimal hyperplasia, lumen irregularities, and flow disturbances.
- The long-term clinical impact of this intervention requires further evaluation.
Purpose of the Study:
- To evaluate the effect of saphenous vein graft external stenting on clinical outcomes up to 5 years post-CABG.
- To compare real-world outcomes of external stenting with historical control data.
Main Methods:
- A propensity-matched analysis compared patients who received external vein graft stenting with controls from the Arterial Revascularization Trial.
- The primary endpoint was major adverse cardiovascular and cerebrovascular events at 1 year, including mortality, myocardial infarction, repeat revascularization, and stroke.
- Secondary endpoints included 5-year outcomes and annualized target vessel revascularization rates.
Main Results:
- External stenting was associated with a significantly lower risk of composite adverse outcomes at 1 year (HR 0.60, P=.03) and 5 years (HR 0.70, P=.04) post-CABG.
- Annual target vessel revascularization rates in vein grafts were significantly lower in the stented group from 2 to 5 years post-surgery (P=.009-.03).
- The study included 789 treated patients and 2205 control patients.
Conclusions:
- External saphenous vein graft stenting is associated with significantly reduced adverse clinical outcomes up to 5 years post-CABG.
- This intervention offers a potential improvement over standard care for patients undergoing CABG with vein grafts.
- The benefits include a lower risk of major adverse cardiovascular events and repeat revascularization.
Objective:
External saphenous vein graft stenting has been shown to reduce intimal hyperplasia, lumen irregularities, and flow disturbances after coronary artery bypass grafting (CABG). The objective of this study is to evaluate the effect of saphenous vein graft external stenting on clinical outcomes up to 5 years.
Methods:
Outcomes for patients who received external vein graft stenting in an international, real-world cohort were compared in a propensity matched analysis with patients from the Arterial Revascularization Trial (ISRCTN46552265). All eligible patients required an internal mammary artery graft to the left anterior descending coronary artery, received at least one vein graft, and survived to discharge. The primary end point was major adverse cardiovascular and cerebrovascular events at 1 year after surgery, consisting of all-cause mortality, myocardial infarction, repeat revascularization, and cerebrovascular accident. Secondary end points included 5-year major adverse cardiovascular and cerebrovascular events with and without stroke and annualized target vessel revascularization.
Results:
In total, 789 treated and 2205 control patients were included. At 1 year after CABG, the weighted hazard ratio comparing outcomes between treated and control patients was 0.60 (90% confidence interval, 0.38-0.94, P = .03). The benefits associated with external stenting for the composite outcome persisted through 5 years' post-CABG (hazard ratio, 0.70; 95% confidence interval, 0.51-0.98, P = .04). Annual target vessel revascularization rates in vein grafts were significantly lower in the venous external support cohort at 2 to 5 years after surgery (P = .009-.03).
Conclusions:
The current study demonstrates that external vein graft stenting is associated with a significantly lower risk of experiencing adverse clinical outcomes up to 5 years after surgery compared with standard of care.
