Venous Support System Improves CABG Outcomes

A novel device could lead to increased longevity and durability of saphenous vein grafts (SVG) during coronary artery bypass graft (CABG) surgery, according to a new study.

The venous external support (VEST) system, under development by Vascular Graft Solutions (VGS; Tel Aviv, Israel) is a fine, kink-resistant cobalt-chromium wire mesh that is placed over a SVG to prevent non-uniform graft dilatation post-implantation, mitigate formation of disturbed blood flow patterns, and prevent subsequent development of intimal hyperplasia. Two models are available (VEST and VEST 2.0); VEST 2.0 is more pliable, as it is braided of thinner wires, and can be cut intraoperatively by the surgeon to fit desired SVG length.

The results of a recent randomized, controlled, clinical trial comparing VEST supported and non-supported vein grafts up to five years post CABG demonstrated that VEST can mitigate pathological remodeling of SVGs, significantly reduce intimal hyperplasia and lumen irregularities, and improves blood flow hemodynamics. The study was presented as a late-breaking clinical trial during the virtual American Heart Association Scientific Sessions, broadcast from Dallas (TX, USA) during November 2021.

“Vein grafts have a limited durability; about half of them will be closed ten years after CABG. We need to find a solution to improve outcomes of surgery and prevent complications and repeated procedures,” said lead author and study presenter John Puskas, MD, chair of cardiovascular surgery at Mount Sinai Morningside (NY, NY, USA). “Among patients with complete intravascular ultrasound data, VEST was associated with statistically reduced intimal hyperplasia.”

SVGs are the most frequently used bypass conduits in CABG surgery. But saphenous veins normally experience low pressure in the leg; the higher-pressure environment of the coronary arteries can cause intimal hyperplasia, which promotes atherosclerosis and may lead to eventual closure. SVG failure rates range from 35% to 50% (five to ten years following CABG surgery), doubling the risk for re-intervention.

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