Graft Patency Rates Research Articles

Short-Term Outcomes of Total Arterial Revascularization Compared to Conventional Coronary Artery Bypass Graft in Patients with Multivessel Disease and Left Ventricular Dysfunction

Background. Multivessel coronary artery disease (CAD) and left ventricular dysfunction (LVD) present challenges in CABG. We aimed to compare early outcomes of total arterial revascularization (TAR) versus conventional CABG in this high-risk population. Methods. This was a retrospective cohort study based on a single-center registry of patients who underwent isolated CABG for multivessel CAD and LVD between January 2014 and December 2022. Primary outcome was in-hospital mortality. Secondary outcomes were early complications, graft patency rate at 3 months, readmission rate within 6 months, and freedom from angina rate within 6 months. Results. A total of 112 cases were included in this study; 52 patients for TAR and 60 patients for conventional CABG. Both groups had comparable baselines and operative profiles. In-hospital mortality was similar between TAR and conventional CABG (2 deaths, 3.85% vs 4 deaths, 6.67%, p = 0.810). TAR had shorter ICU (3.5 vs 5 days, p = 0.016) and hospital stay (10.5 vs 12 days, p = 0.007). Other postoperative complications were similar. At 3 months, TAR had superior graft patency (91.7% vs 83.7%, p = 0.034) and lower 6-month readmission (TAR: 2/50, 4.0% vs. CR: 10/56, 17.9%, p = 0.024). Freedom from angina rate within 6 months was similar between the two groups (TAR: 43/50, 86.0% vs. CR: 42/56, 75.0%, p = 0.240). Conclusion. Our findings suggest that TAR may offer benefits in terms of shorter hospital stays, higher early graft patency, and lower readmission rates for patients with multivessel CAD and LVD. However, further research, particularly large-scale, randomized trials with longer follow-up periods, are needed to fully understand the long-term clinical outcomes and confirm these promising early results.

Radial artery graft in coronary artery bypass surgery 1 week to 1 year postoperation.

The actual patency rate of the radial artery (RA) grafts 1 week and 1 year after coronary artery bypass grafting (CABG) has not been extensively reported on. We used coronary computed tomography angiography (CCTA) to evaluate the patency rate of RA grafts and compared it with that of saphenous vein (SV) grafts. In this observational cohort study, 80 patients who underwent urgent or elective CABG with RA and SV grafts at Ruijin Hospital from August 2019 to June 2021 were included. Follow-up CCTA scans were completed about 1 year postoperation in the out-patient clinic. We graded the grafts into four classes: A, excellent; B, graft diameter <50% of target coronary artery; O, occluded; and S, string sign. Both S and O were defined as graft failure. The patients' mean age was 58.48±8.06 years, and 87.5% (70/80) of the patients were male. The 1-week patency rate of the left internal mammary artery (LIMA), RA, and SV grafts were 98.7% (75/76), 76.3% (61/80), and 93.8% (75/80), respectively. At 1 year, the patency rate of the LIMA, RA, and SV grafts were 97.4% (74/76), 80.0% (64/80), and 81.3% (65/80), respectively. The RA graft patency rate was lower than was the SV graft patency rate perioperatively [relative risk (RR): 0.918; 95% confidence interval (CI): 0.852-0.990; P=0.007]. Moreover, 63.6% (7/11) of RA grafts graded S and 25.0% (2/8) of RA grafts graded O were defined as patent (graded A or B) at 1 year postoperation. Compared with SV grafts, more RA grafts improved (RA: 12/80, 15.0%; SV: 0%) and fewer RA grafts deteriorated (RV: 10/80, 12.5%; SV: 19/80, 23.8%) from 1 week to 1 year (P=0.001). The patency rate of the 2 types of grafts became similar at 1 year postoperation (RR: 0.560; 95% CI: 0.113-2.781; P>0.99). RA grafts had a lower patency rate than did SV grafts 1 week after operation. However, because of the "revival" phenomena and lower attrition rate, the patency rate of the two kinds of grafts did not show any significant difference at 1 year.

Postoperative Outcomes and One-Year Mortality of Patients on Chronic Anticoagulation Medications Undergoing Infrainguinal Bypass

Patients requiring open infrainguinal bypass (IIB) frequently are taking chronic anticoagulation (AC) medications. Taking these medications in the preoperative setting may affect the outcomes of surgery. This study aims to evaluate postoperative outcomes and 1-year mortality of patients taking chronic AC medications that undergo IIB. Using data obtained from the Vascular Quality Initiative from January 2011 to October 2021, patients on warfarin or any direct oral anticoagulants (DOAC) within 30days of IIB were compared with patients not taking chronic AC medications. The primary outcomes were in-hospital, 30-day, and 1-year mortality. The secondary outcomes included total procedure time, need for perioperative packed red blood cell transfusion, prolonged length of hospital stay, postoperative myocardial infarction or stroke, and graft patency at discharge. A subgroup analysis was performed comparing patients taking warfarin with those taking DOACs. Univariate analyses and multivariate logistic regression, Kaplan Meier survival, and Cox regression analyses were used to analyze the data for postoperative and 1-year outcomes, respectively. A total of 55,076 patients underwent IIB during the study period, and 11,547 (20.97%) were on chronic AC prior to surgery. The 2 cohorts differed significantly in almost every demographic and clinical characteristic. Multivariate analyses adjusting for 45 potential confounders revealed that there was no significant difference in in-hospital, 30-day, and 1-year mortality. The total procedure time for the chronic AC cohort was on average 11.46±2.16min longer (P ≤ 0.001) and there was a greater risk of prolonged length of stay in the hospital (adjusted odds ratio [aOR]: 1.19, 95% confidence interval [CI]: 1.13-1.26, P<0.001). These patients also returned to the operating room (OR) at a greater rate (aOR: 1.12, 95% CI: 1.05-1.19; P=0.016) and demonstrated a significantly lower rate of graft patency at discharge (aOR: 0.73, 95% CI: 0.62-0.86, P=0.001). On subgroup analysis, multivariate analysis demonstrated lower 30-day mortality for the DOAC group in comparison to the warfarin group (aOR: 0.74, 95% CI: 0.57-0.94, P=0.015), but no significant differences in in-hospital and 1-year mortality. Patients taking AC medications within 30days prior to IIBs may require more perioperative red blood cell transfusions, longer hospitalizations, and return to the OR at a greater rate. They are also at an increased risk for loss of graft patency at discharge. However, these patients are not at increased risk of in-hospital, 30-day, or 1-year mortality. IIB can, therefore, be performed safely in patients taking chronic AC medications.

No-Touch Saphenous Vein as Y-Composite vs Aortocoronary Graft: Early Outcome Analysis

BackgroundA randomized controlled trial was designed to compare 1-year morphologic changes of the no-touch saphenous vein (SV) as a Y-composite graft (composite group) vs an aortocoronary graft (aorta group) in coronary artery bypass grafting. This study evaluated early clinical and angiographic outcomes as a preliminary analysis. MethodsThe primary end point of the trial was the intima-media thickness measured by intravascular ultrasound at 1-year angiographic follow-up. Patients were screened to enroll 25 patients in each group based on a superiority design. Early postoperative clinical and angiographic outcomes were compared between the 2 groups. ResultsThe numbers of distal anastomoses per SV graft were 2.7 ± 1.1 and 2.6 ± 0.8 in the composite and aorta groups, respectively. There was no operative death, and postoperative complications in the 2 groups did not significantly differ. All patients underwent early postoperative graft angiography at a median of 1 (interquartile range, 1-1) day after operation. Early angiographic patency rates were 98.9% (93/94 anastomoses) and 100% (90/90 anastomoses) in the composite and aorta groups, respectively. There was no distal anastomosis showing competitive flow in the aorta group, whereas 3 anastomoses with competitive flow were found in the composite group. All 3 anastomoses with competitive flow were SV grafts that were anastomosed to the right coronary artery territory with moderate stenosis. ConclusionsEarly clinical outcomes and angiographic graft patency rates were not significantly different with use of no-touch SV as a Y-composite graft or an aortocoronary graft.

Conduit quality control protocol in CABG

Cardiac revascularization surgery has a long history. Its results and safety are well known. Nonetheless, the long-term patency rate of certain grafts used in cardiac revascularization is non-optimal, and CABG is associated with a risk of cerebrovascular stroke due to aortic manipulation. We have developed a simple control quality protocol of the anastomosis performed in CABG, aiming to improve the long-term patency of certain grafts used in cardiac revascularization surgery and reduce the risk of cerebrovascular stroke in those patients.

Patency and Durability of Stent Grafts Placed in the Dialysis Circuit Cannulation Zone

PurposeTo investigate the safety, durability, and patency rates of stent grafts (SGs) placed in the cannulation zone of hemodialysis access circuits. Materials and MethodsFrom April 2020 to April 2023, all procedures with SGs placed in the cannulation zone were retrospectively analyzed. A total of 40 patients (25 men and 15 women) with SGs placed in the cannulation zone were included in the study. Mean age of the patients was 70 years. The Covera covered stent (BD, Franklin Lakes, New Jersey) was used in all cases. Of these, 26 were arteriovenous (AV) fistulae and 14 were AV grafts. SGs were placed for residual stenosis, perforation, aneurysm, and thrombosis. Follow-up outcomes were determined using follow-up angiographic images and included primary patency, primary-assisted patency, and secondary patency. ResultsThe primary patency of the target lesion was 89% (SD ± 5) and 74% (SD ± 8.4) at 6 and 12 months, respectively. The primary-assisted patency was 89% (SD ± 5.2) and 78% (SD ± 7.6) at 6 and 12 months, respectively. Secondary patency of the access circuit was 97% (SD ± 2.5) at both 6 and 12 months. Mean follow-up was 332 days (range, 28–661 days). All SGs were successfully cannulated for hemodialysis. No cases of stent fracture or stent infection were observed during follow-up. ConclusionsSGs placed for cannulation zone pathologies can be safely cannulated for dialysis and have adequate short- and mid-term patency rates.

Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review.

Coronary artery bypass grafting (CABG) has witnessed remarkable progress in recent years, driven by innovative techniques and refined approaches that have transformed patient outcomes and treatment paradigms. This review article comprehensively explores the latest advances in CABG techniques and their consequential impacts on patient outcomes. The advent of minimally invasive CABG techniques has revolutionized traditional surgical approaches. Robotic-assisted surgery and small thoracotomy methods offer reduced invasiveness, yielding shorter recovery times and improved patient satisfaction. Integrating CABG with percutaneous coronary intervention (PCI), hybrid procedures have emerged as a versatile strategy, providing tailored treatment solutions for complex coronary anatomies. The paradigm shift to off-pump CABG, which preserves the beating heart during surgery, has shown promise in reducing perioperative complications and neurocognitive deficits. Advances in graft selection, particularly the utilization of arterial grafts such as the internal thoracic artery and radial artery, have significantly enhanced graft patency rates and long-term survival. Adjunctive technologies, such as intraoperative imaging and graft flow assessment, have bolstered the precision of CABG procedures. Pharmacological agents have demonstrated their potential to improve graft outcomes. Surgical decision-making is now optimized based on patient characteristics and disease severity owing to the development of patient selection and risk stratification tools. Long-term results have also significantly improved. Patients undergoing CABG have higher survival rates, less angina, and better quality of life. Developing more resilient grafts through tissue engineering, using bioresorbable materials in graft fabrication, and using gene therapy to improve graft patency and overall cardiac recovery are all exciting future research directions. This review's summary of current developments in CABG procedures highlights their profoundly positive effects on patient outcomes. These developments can change the face of cardiovascular care by giving clinicians more tools to treat coronary artery disease (CAD) and enhance patients' quality of life.

Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases

To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysm at a single centre. This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysm between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). Overall post-operative 90 day mortality was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.

Paracolic Gutter Routing: A Novel Retroperitoneal Extra-Anatomical Repair for Infected Aorto-Iliac Axis.

We describe and analyze outcomes of a novel extra-anatomical paracolic gutter routing technique for surgical repair of aorto-iliac infections. A double-center, observational, cohort study of all consecutive patients with aorto-iliac infections treated using extra-anatomical paracolic gutter technique. Between May 2015 and December 2022, six patients with aorto-iliac infections were treated with the paracolic gutter routing technique. Cases were identified retrospectively in an institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. Aorto-bifemoral vascular reconstructions were performed using this technique in six patients. During mean follow-up of 52 ± 44 months, there was one case of graft thrombosis (17%) with subsequent successful thrombectomy. Primary and secondary graft patency rates were 83% and 100%, respectively. There was one mortality (17%) due to candida sepsis. All graft prostheses were patent at last follow-up. The paracolic gutter technique is a useful technique in patients with extensive aorto-iliac infections, arteriovenous and iliac-ureteric fistulas, or at a high risk of vascular graft infection and is associated with favorable reinfection and patency rates.

Simultaneous hybrid off-pump coronary artery bypass grafting and transcatheter aortic valve implantation in elderly patients.

Optimal strategy for transcatheter aortic valve implantation (TAVI) in patients with coronary artery disease (CAD) is unresolved. We evaluated the surgical outcomes of hybrid coronary artery bypass grafting (CABG) and TAVI in elderly patients. We retrospectively evaluated patients who underwent simultaneous TAVI and CABG at Wakayama Medical University, Japan. All patients underwent off-pump CABG (OPCAB) including minimally invasive cardiac surgery (MICS-CABG). In an earlier period, OPCAB + transfemoral TAVI (TF-TAVI) was the only method used, while in a later period, we introduced MICS-CABG and alternative approaches for TAVI. Twenty-seven patients were enrolled, the average age was 83.6 ± 5.1years. In the MICS-CABG and TAVI group, average patient age was higher (87.0 ± 3.1years) than in the earlier group. Thirty-day and in-hospital mortalities were zero. Incomplete revascularization rate was 33.3% and one patient required percutaneous coronary intervention after the operation. Graft patency rate was 100%. In MICS-CABG group, the number of distal anastomoses was smaller (1.29, range 1-2), but the number of days required to re-starting walking and postoperative hospital stay were shorter, and the rate of discharge to home was higher (100%) than in the other groups. Although 33.3% of patients did not achieve complete revascularization, there was no 30-day or in-hospital mortality. TAVI and hybrid OPCAB, including MICS-CABG, were suggested to be feasible treatment in elderly patients.

Graft Patency of No-Touch Saphenous Veins Used as Aortocoronary Bypass Grafts.

This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG). In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated. The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively. The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.

Branched endovascular iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation graft: outcomes and reinterventions in our retrospective cohort.

The aim of this retrospective cohort study was to analyze the outcomes and the need for reinterventions following branched iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation (ZBIS; Cook Medical Europe LTD, Limerick, Ireland) graft. Patient characteristics and follow-up data on 63 patients following branched iliac artery repair using the ZBIS device were evaluated and compared between patients with and without iliac reinterventions. A competing risk regression model was analyzed to identify independent predictors of reinterventions, and to predict the reintervention risk. ZBIS implantation's technical success rate was 100%, and we observed no in-hospital mortality. Internal iliac artery patency was 93% during a median [first quartile, third quartile] follow-up of 19 [5, 39] months. Thirty-two iliac reinterventions were performed in 23 patients (37%) after a mean time of 3.0 months (IQR: 0.4-6.8) (time to first reintervention). Endoleaks type I and II were the most common indication for reinterventions (n=14, 61%). The internal iliac artery's diameter [subdistribution hazard ratio (sHR): 1.046; P=0.0015] and a prior abdominal aortic intervention (sHR: 0.3331; P=0.0370) were identified as significant variables in the competing risk regression model for a reintervention. The risk for reintervention was 33% (95% CI: 20-46%), and 46% (95% CI: 28-63%) after 12 and 36 months, respectively. Endovascular repair of degenerative iliac artery aneurysms with Zenith Branch Iliac Bifurcation device is a feasible and safe option. Perioperative morbidity and mortality are low with good graft patency rates. The risk for secondary iliac artery interventions is considerable and highlights the need for patients with iliac disease to undergo continuous follow-up in a dedicated vascular center.

Coronary endarterectomy combined with coronary artery bypass grafting might decrease graft patency: A cohort study

BackgroundLittle is known about the graft patency after coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG). This study aimed to investigate the graft patency after CABG + CE. MethodsEligible patients hospitalized at our center during September 2008 and July 2022 with complete follow-up coronary angiographic data available were retrospectively enrolled. The primary end point was the follow-up graft patency of CE targets. Logistic regression was performed to explore the potential predictors of the CE-targeted graft failure. ResultsA total of 160 patients (age: 59.4 ± 9.3 years, male: 75.6%) were enrolled, and 560 grafts were anastomosed. CE was performed on 166 sites, including LAD (36.1%), right coronary artery (RCA, 48.2%), left circumflex artery (9.6%), and diagonal branches (6.0%). Postoperative myocardial infarction was observed in 7 (4.4%) of the patients. During a median follow-up of 12.1 months, the CE-targeted graft patency was 69.9%. The CE-targeted graft patency rate was much higher among the LAD-CE patients than the non-LAD-CE patients (80.0% vs. 64.2%, P = 0.032) but lower than non-endarterectomized LAD (80.0% vs. 92.9%, P = 0.013). No difference was observed regarding the graft patency between off-pump and on-pump surgery (P = 0.585). In the logistic regression, RCA-CE was associated with an increased risk of graft failure even after multiple adjustments (odds ratio: 2.35, 95% confidence interval: 1.05–5.28, P = 0.028). ConclusionsCABG + CE might be associated with decreased graft patency, especially in those who received RCA-CE, irrespective of surgical technique or antiplatelet/anticoagulation regimen. A multi-center prospective, possibly randomized study with a larger sample size is warranted.

Technical Outcomes of Porto-Mesenteric Venous Reconstruction in Pancreatic Resection Using Autologous Left Renal Vein Graft as Conduit.

Portal or superior mesenteric vein (PV-SMV) resection and reconstruction is sometimes required during pancreatic tumor resection. In patients requiring segmental venous resection with interposition grafting, the left renal vein (LRV) is an accessible autologous solution. However, long-term patency outcomes of the LRV as an interposition conduit in this setting have not been analyzed. We conducted a retrospective analysis of patients undergoing pancreatic resection with PV-SMV reconstruction using LRV between 2002 and 2022. The primary outcome was PV-SMV patency at last follow-up, assessed with postoperative CT scans and analyzed using Kaplan-Meier survival methods that account for variation in follow-up duration. Development of any postoperative acute kidney injury within 7 days of surgery and morbidity were secondary outcomes. The study cohort includes 65 patients who underwent LRV harvest; 60 (92%) ultimately underwent successful reconstruction with harvested LRV graft. Kaplan-Meier 2-year estimated patency rate of the LRV graft was 88%, with no cases of complete occlusion. Six (10%) patients experienced graft stenosis. Nine of 61 (15%) patients experienced grade II or III acute kidney injury, 6 of 9 returning to normal renal function before discharge. No difference in median serum creatinine was observed at baseline, 6 and 12 months from surgery. LRV remnant thrombosis was seen in 7 of 65 (11%) patients. Only 3 of 61 (5%) patients had persistent acute kidney injury caused by complications unrelated to LRV harvesting. Autologous LRV graft was a reliable conduit for segmental PV-SMV reconstruction, resulting in a high patency rate and marginal impact on renal function. LRV harvest is a safe and potentially ideal surgical option for PV-SMV reconstruction in pancreatic surgery.

Outcomes of Aortobifemoral Bypass Based on Configuration of the Proximal Anastomosis

Aortobifemoral bypass (ABF) remains an important treatment modality in the revascularization of aortoiliac occlusive disease. Despite ABF being performed for decades, questions remain regarding the preferred technique for the proximal anastomosis, specifically whether an end-to-end (EE) or an end-to-side (ES) configuration is superior. The goal of this study was to compare the outcomes of ABF based on proximal configuration. We queried the Vascular Quality Initiative (VQI) registry for ABF procedures performed between 2009 and 2020. Univariate and multivariate logistic regression analyses were used to compare peri-operative and 1-year outcomes between EE and ES configurations. Of the 6782 patients (median (interquartile range) age, 60.0 (54-66 years) who underwent ABF, 3524 (52%) had an EE proximal anastomosis and 3258 (48%) had an ES proximal anastomosis. Post-operatively, the ES cohort had a higher frequency of extubation in the operating room (80.3% vs 77.4%; p<0.01), lower change in renal function (8.8% vs 11.5%; p <0.01), and lower use of vasopressors (15.6% vs 19.1%; p<0.01), but higher rates of unanticipated return to the operating room (10.2% vs 8.7%; p=0.037) compared with the EE configuration. At 1-year follow up, the ES cohort had a significantly lower primary graft patency rate (87.5% vs 90.2%; p<0.01) and higher rates of graft revision (4.8% vs 3.1%; p<0.01), and claudication symptoms (11.6% vs 9.9%; p<0.01). The ES configuration was significantly associated with a higher rate of 1-year major limb amputations in univariate (1.6% vs 0.9%; p<0.01) and multivariate (OR, 1.95, CI, 1.18-3.23, p=<0.01) analyses. While the ES cohort seemed to have less physiologic insult immediately post-operatively, the EE configuration appeared to have improved 1-year outcomes. To our knowledge, this study is one of the largest population-based studies comparing the outcomes of the proximal anastomotic configurations. Longer-term follow-up is needed to determine which configuration is optimal.

Importance of Limb Severity on Primary Graft Patency of Ipsilateral Single Saphenous Vein Grafts for Lower Extremity Artery Bypass in Chromic Limb-threatening Ischemia

Approximately 30% of infrainguinal vein bypasses fail within 2 years after placement. A previous study demonstrated limb severity influenced cellular responses of saphenous veins used for lower extremity arterial bypass. The aim of this study was to assess the impact of wound, ischemia, and foot infection (WIfI) on primary graft patency of ipsilateral saphenous vein grafts. This is a retrospective, observational cohort study of autogenous vein bypass for chromic limb-threatening ischemia. Between 2014 and 2019, 201 (of 253) limbs receiving ipsilateral single great saphenous vein grafts were enrolled as research subjects. The outcome of interest was loss of primary graft patency >1 month after surgery because of occlusion or intervention for graft stenosis. Perioperative graft failure due to technical error successfully repaired by revision surgery were included; however, perioperative unrepaired failed graft and patients dying within 30 days after surgery were excluded, leaving 191 vein grafts for analysis of 2-year primary graft patency. Factors associated with loss of graft patency were predicted by Cox regression modeling based on patients’ background and limb severity. Seventy-six grafts (40%) lost primary patency at 2 years after surgery. The highest stage of WIfI classification had significantly lower primary graft patency than a bundle of other lower stages (49% vs 66%; P = .04). When focusing on the three factors of WIfI, higher wound grade (2 and 3) significantly impaired graft patency compared with lower grade (49% vs 68%; P = .016) and existence of foot infection (grade 1-3) also impaired primary graft patency rate (49% vs 63%; P < .05). There was a trend to lower patency for ischemia grade 3 than grade 2 (54% vs 65%; P = .06). Female sex (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.0-2.6; P = .04), chronic heart failure (HR, 2.0; 95% CI, 1.2-3.2; P < .01), higher wound grade (HR, 1.9; 95% CI, 1.1-3.1; P = .01) were significant by multivariate analysis. Intriguingly, the impact of wound and foot infection grade on loss of primary patency was not significant for men (n = 129 limbs) (P = .35 for wound and P = .30 for foot infection); however, it was for women (n = 62 limbs) (P = .018 for wound and P = .059 for foot infection). Limb severity as classified by WIfI, especially wound grade, was associated with loss of primary graft patency. This impact was weighted in women, not men; hence, further basic investigation will be needed with focus on differing cellular responses of saphenous vein stratified by sex.

Abstract 655: Protecting The Saphenous Vein Endothelium During Bypass Surgery

Coronary artery bypass graft surgeries commonly use saphenous vein grafts to revascularize diseased coronary arteries. Despite surgical and pharmacological advancements, graft failure rates remain high. Loss of endothelial cells (EC) during saphenous vein harvest and preservation likely contributes to the high incidence of graft failure. Standard methods of saphenous vein preparation and preservation during surgery include perfusion with heparinized saline solutions, a practice known to induce EC damage. As such, improved methods of saphenous vein storage may be the key to preserving EC and reducing graft failure rates. Here, we assessed the hypothesis that maintaining saphenous veins in autologous heparinized blood would preserve EC coverage and reduce cellular damage compared to standard of care, heparinized saline. To investigate this, saphenous vein tissues from 12 patients undergoing coronary artery bypass graft surgery were split into 2 treatment groups, 1) standard maintenance in heparin-saline (n=6) and 2) maintenance in heparin-blood (n=6). At the end of the surgeries, excess saphenous vein tissues were immediately fixed in 4% PFA to analyze endothelial coverage and DNA damage. In heparin-saline veins, histological analysis by H&amp;E and Movat pentachrome staining revealed a broken or absent luminal layer and exposed lamina matrix, suggesting a loss of endothelial cell coverage. Luminal cell coverage was notably increased in heparin-blood samples. Immunofluorescent staining of endothelial markers VE-cadherin and endothelial nitric oxide identified a significant improvement in endothelial coverage in the heparin-blood group compared to heparin-saline. To determine the health of remaining endothelial cells, DNA damage was measured using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Our data show that most of the endothelium (VE-cadherin positive) in heparin-saline tissues was TUNEL positive compared with heparin-blood. In conclusion, our data indicate that maintaining saphenous vein tissues in solutions containing autologous heparinized blood helps preserve the endothelium and maintains vein graft health which has the potential to improve vein graft patency rates in patients.

Resealable Antithrombotic Artificial Vascular Graft Integrated with a Self-Healing Blood Flow Sensor.

Coronary artery bypass grafting is commonly used to treat cardiovascular diseases by replacing blocked blood vessels with autologous or artificial blood vessels. Nevertheless, the availability of autologous vessels in infants and the elderly and low long-term patency rate of grafts hinder extensive application of autologous vessels in clinical practice. The biological and mechanical properties of the resealable antithrombotic artificial vascular graft (RAAVG) fabricated herein, comprising a bioelectronic conduit based on a tough self-healing polymer (T-SHP) and a lubricious inner coating, match with the functions of autologous blood vessels. The self-healing and elastic properties of the T-SHP confer resistance against mechanical stimuli and promote conformal sealing of suturing regions, thereby preventing leakage (stable fixation under a strain of 50%). The inner layer of the RAAVG presents antibiofouling properties against blood cells and proteins, and antithrombotic properties, owing to its lubricious coating. Moreover, the blood-flow sensor fabricated using the T-SHP and carbon nanotubes is seamlessly integrated into the RAAVG via self-healing and allows highly sensitive monitoring of blood flow at low and high flow rates (10- and 100 mL min-1, respectively). Biocompatibility and feasibility of RAAVG as an artificial graft were demonstrated via ex vivo, and in vivo experiment using a rodent model. The use of RAAVGs to replace blocked blood vessels can improve the long-term patency rate of coronary artery bypass grafts.

Comparative effectiveness of clopidogrel versus aspirin as a maintenance monotherapy 1 year after coronary artery bypass grafting.

Data on the safety and efficacy of clopidogrel (CPD) monotherapy after coronary artery bypass grafting (CABG) are limited. We compared the clinical outcomes and graft patency rates during 4 years in CABG patients who maintained CPD or aspirin after 1 year of dual antiplatelet therapy (DAPT) use. A total of 671 patients who maintained 1-year DAPT after CABG with all grafts patent on one-year follow-up angiography and switched to single antiplatelet therapy (SAPT) using CPD (n = 272) or aspirin (n = 399) between January 2009 and December 2015 were enrolled. Propensity score matching analysis was used, and 227 pairs were matched in a 1:1 ratio. Overall mortality, cardiac mortality, and major adverse events, including all-cause mortality, acute myocardial infarction, coronary reintervention or reoperation, ischaemic stroke, and major bleeding, were compared. Graft patency was evaluated using graft angiography 5 years post-surgery. Overall survival and the incidence of major adverse events during the 4-year follow-up did not differ significantly between the groups when un-matched (hazard ratio [HR], 95% confidence interval [CI]=1.24, 0.71 to 2.15, P = 0.46 and HR, 95% CI = 1.22, 0.77 to 1.92, P = 0.41, respectively) or matched (HR, 95% CI = 1.05, 0.55 to 2.01, P = 0.89 and HR, 95% CI = 1.01, 0.60 to 1.73, P = 0.96, respectively). In the postoperative 5-year graft angiography, new graft occlusion was found in 3.2% and 4.7% of patients and newly occurred graft occlusion rates of distal anastomoses were 1.2% and 1.6% in the CPD and aspirin groups, respectively, and were not statistically different between the 2 groups (P = 0.39 and 0.63, respectively). Changes of antiplatelet regimen were needed in 22.8% (91 of 399) of aspirin group and in 2.2% (6 of 272) of CPD group from the initiation of SAPT (P < 0.001). In this series of patients undergoing CABG who received DAPT and remained stable for 1 year, SAPT maintenance with CPD or aspirin did not show any significant differences in 4-year outcomes such as all-cause mortality, major adverse events, and newly occurring graft occlusion. However, more patients taking aspirin required changes in antiplatelet regimens to other antiplatelet or anticoagulation therapies.

Arteriovenous Grafts: Still a Viable Option? A 5-Year Study

Background: Hemodialysis patients require a vascular access that is both reliable and long lasting. Several variables, including population changes and comorbidities, have impacted patency rates. This study analyzes multiple parameters and estimates the patency rates and complications of brachioaxillary arteriovenous (AV) prosthetic grafts used for dialysis access in a single center. Materials and Methods: This was a prospective single-center study conducted at the Ramaiah Medical College Hospital in Bengaluru. This study comprised 92 patients with chronic renal failure who had brachioaxillary AV prosthetic graft surgery for dialysis access between 2018 and 2022. We monitored cases for up to 2 years for complications, and the primary and secondary graft patency rates were reported. Results: Seventy-five percent of the participants were male, with a mean age of 60. Diseases including hypertension (72.9% prevalence), diabetes (38.2%), and coronary artery disease (20.7% prevalence) were also very common. The present investigation found that thrombosis was the most frequent problem, followed by stenosis. In this study, the primary graft patency rates after 1 year and 2 years were 60.5% and 48%, respectively, whereas the secondary graft patency rates at 1 year and 2 years were 69% and 58%, respectively. Conclusion: The outcomes of this study regarding graft patency and complication rates compare favorably with other published data. Therefore, the authors consider brachioaxillary AV to be the optimal HD route when no acceptable forearm veins are available for creating AV fistulas.