Saphenous Vein Graft Research Articles

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

Successful surgical treatment for primary cardiac angiosarcoma: a case report

BackgroundPrimary cardiac angiosarcomas are extremely rare and their prognosis is poor. Surgical resection is the first-line treatment; however, no clear standard of care has been clearly established because of the rarity of these tumors.Case presentationA 61-year-old man who had presented with dyspnea on exertion was referred to our hospital. Contrast-enhanced computed tomography revealed massive pericardial effusion and a 40-mm enhanced mass adherent to the anterior wall of the right atrium and involving the right coronary artery. Having diagnosed the mass as a cardiac tumor, we resected the mass under the guidance of epi-cardiac echocardiography guidance, which showed continuity between the tumor and the right atrium, reconstructed the right atrial free wall with a bovine pericardial patch, and performed coronary artery bypass grafting to the right coronary artery using the great saphenous vein. The right atrial wall was resected with adequate tumor-free margin. On the right ventricular side, we resected the right atrial wall 1 cm from the tumor, 2 cm from the atrioventricular groove. Because hemodynamic deterioration occurred after aortic declamping, intra-aortic balloon pumping and veno-arterial extracorporeal membrane oxygenation were instituted. Postoperatively, circulatory support devices were removed safely, and the patient was discharged on the 25th postoperative day. Histopathological examination of the surgical specimens resulted in a diagnosis of angiosarcoma, with positive surgical margins. Chemotherapy and radiotherapy (69 Gy in 30 fractions) were therefore initiated after discharge. To date, the patient has been alive and well with no recurrence of tumor for 4 years and 10 months since surgery.DiscussionThis case study suggests the usefulness of multimodality treatment comprising surgical resection and adjuvant therapy, for cardiac angiosarcoma.

Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management.

The use of saphenous vein grafts (SVGs) in the surgical management of obstructive coronary artery disease remains high despite a growing understanding of their limitations in longevity. In contemporary practice, approximately 95% of patients receive one SVG in addition to a left internal mammary artery (LIMA) graft. The precise patency rates for SVGs vary widely in the literature, with estimates of up to 61% failure rate at greater than 10 years of follow-up. SVGs are known to progressively degenerate over time and, even if they remain patent, demonstrate marked accelerated atherosclerosis. Multiple studies have demonstrated a marked acceleration of atherosclerosis in bypassed native coronary arteries compared to non-bypassed arteries, which predisposes to a high number of native chronic total occlusions (CTOs) and subsequent procedural challenges when managing graft failure. Patients with failing SVGs frequently require revascularisation to previously grafted territories, with estimates of 13% of CABG patients requiring an additional revascularisation procedure within 10 years. Redo CABG confers a significantly higher risk of in-hospital mortality and, as such, percutaneous coronary intervention (PCI) has become the favoured strategy for revascularisation in SVG failure. Percutaneous treatment of a degenerative SVG provides unique challenges secondary to a tendency for frequent superimposed thrombi on critical graft stenoses, friable lesions with marked potential for distal embolization and subsequent no-reflow phenomena, and high rates of peri-procedural myocardial infarction (MI). Furthermore, the rates of restenosis within SVG stents are disproportionately higher than native vessel PCI despite the advances in drug-eluting stent (DES) technology. The alternative to SVG PCI in failed grafts is PCI to the native vessel, 'replacing' the grafts and restoring patency within the previously grafted coronary artery, with or without occluding the donor graft. This strategy has additional challenges to de novo coronary artery PCI, however, due to the high burden of complex atherosclerotic lesion morphology, extensive coronary calcification, and the high incidence of CTO. Large patient cohort studies have reported worse short- and long-term outcomes with SVG PCI compared to native vessel PCI. The PROCTOR trial is a large and randomised control trial aimed at assessing the superiority of native vessel PCI versus vein graft PCI in patients with prior CABG awaiting results. This review article will explore the complexities of SVG failure and assess the contemporary evidence in guiding optimum percutaneous interventional strategy.

Feasibility and accuracy of real-time 3D-holographic graft length measurements.

Mixed reality (MR) holograms can display high-definition images while preserving the user's situational awareness. New MR software can measure 3D objects with gestures and voice commands; however, these measurements have not been validated. We aimed to assess the feasibility and accuracy of using 3D holograms for measuring the length of coronary artery bypass grafts. An independent core lab analyzed follow-up computer tomography coronary angiograms performed 30 days after coronary artery bypass grafting in 30 consecutive cases enrolled in the FASTTRACK CABG trial. Two analysts, blinded to clinical information, performed holographic reconstruction and measurements using the CarnaLife Holo software (Medapp, Krakow, Poland). Inter-observer agreement was assessed in the first 20 cases. Another analyst performed the validation measurements using the CardIQ W8 CT system (GE Healthcare, Milwaukee, Wisconsin). Seventy grafts (30 left internal mammary artery grafts, 31 saphenous vein grafts, and 9 right internal mammary artery grafts) were measured. Holographic measurements were feasible in 97.1% of grafts and took 3 minutes 36 s ± 50.74 s per case. There was an excellent inter-observer agreement [interclass correlation coefficient (ICC) 0.99 (0.97-0.99)]. There was no significant difference between the total graft length on hologram and CT [187.5 mm (157.7-211.4) vs. 183.1 mm (156.8-206.1), P = 0.50], respectively. Hologram and CT measurements are highly correlated (r = 0.97, P < 0.001) with an excellent agreement [ICC 0.98 (0.97-0.99)]. Real-time holographic measurements are feasible, quick, and accurate even for tortuous bypass grafts. This new methodology can empower clinicians to visualize and measure 3D images by themselves and may provide insights for procedural strategy.

Axillary artery aneurysms in pediatric patients: A narrative review

Objectives Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms, including loss of extremity function. With the present study we aim to give a comprehensive review of the existing literature focusing on the etiology and management of this rare but threatening pathology. Method A comprehensive review was made in a multi-staged manner. All identified studies have been categorized based on the type of lesions (true or false aneurysm) and their etiologies. Results The treatments differ from the extension of the lesions and from the etiology. Conclusions Open surgery repair with great saphenous vein is still the best long-term approach, but even endovascular, embolization, or conservative management can be considered.

Effect of junctional reflux on the venous clinical severity score in patients with insufficiency of the great saphenous vein (JURY study)

ObjectiveEffective treatment options are available for chronic venous insufficiency associated with superficial venous reflux. Although many patients with C2 and C3 disease based on the CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification have combined great saphenous vein (GSV) and saphenofemoral junction (SFJ) reflux, some may not have concomitant SFJ reflux. Several payors have determined that symptom severity in patients without SFJ reflux does not warrant treatment. In patients planned for venous ablation, we tested whether Venous Clinical Severity Scores (VCSS) are equivalent in those with GSV reflux alone compared with those with both GSV and SFJ reflux. MethodsThis cross-sectional study was conducted at 10 centers. Inclusion criteria were: candidate for endovenous ablation as determined by treating physician; 18 to 80 years of age; GSV reflux with or without SFJ reflux on ultrasound; and C2 or C3 disease. Exclusion criteria were prior deep vein thrombosis; prior vein ablation on the index limb; ilio-caval obstruction; and renal, hepatic, or heart failure requiring prior hospitalization. An a priori sample size was calculated. We used multiple linear regression (adjusted for patient characteristics) to compare differences in VCSS scores of the two groups at baseline, and to test whether scores were equivalent using a priori equivalence boundaries of +1 and −1. In secondary analyses, we tested differences in VCSS scores in patients with C2 and C3 disease separately. ResultsA total of 352 patients were enrolled; 64.2% (n = 226) had SFJ reflux, and 35.8% (n = 126) did not. The two groups did not differ by major clinical characteristics. The mean age of the cohort was 53.9 ± 14.3 years; women comprised 74.2%; White patients 85.8%; and body mass index was 27.8 ± 6.1 kg/m2. The VCSS scores in patients with and without SFJ reflux were found to be equivalent; SFJ reflux was not a significant predictor of VCSS score; and mean VCSS scores did not differ significantly (6.4 vs 6.6, respectively, P = .40). In secondary subset analyses, VCSS scores were equivalent between C2 patients with and without SFJ reflux, and VCSS scores of C3 patients with SFJ reflux were lower than those without SFJ reflux. ConclusionsSymptom severity is equivalent in patients with GSV reflux with or without SFJ reflux. The absence of SFJ reflux alone should not determine the treatment paradigm in patients with symptomatic chronic venous insufficiency. Patients with GSV reflux who meet clinical criteria for treatment should have equivalent treatment regardless of whether or not they have SFJ reflux.

Survival Benefit of Multiple Arterial Revascularization With and Without Supplementary Saphenous Vein Graft.

It is unknown if the presence of saphenous vein grafting (SVG) adversely affects late survival following coronary surgery with multiple arterial grafting (MAG) versus single arterial grafting. A retrospective, observational, multicenter cohort study from 2001 to 2020 was conducted using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database linked to the National Death Index. Patients undergoing primary isolated coronary artery bypass grafting with ≥2 grafts were included, and exclusions were patients aged <18 years, reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Demographics, comorbidities, medication, and operative configurations were propensity score matched between cohorts. The primary outcome was all-cause late death. Of 59 689 eligible patients, 35 113 were MAG (58.8%), and 24 576 were single arterial grafting (41.2%). Of the MAG cohort, 17 055 (48.6%) patients did not receive supplementary SVG(total arterial revascularization). Matching separately generated 22 764 patient pairs for MAG versus single arterial grafting, and 11 137 patient pairs for MAG with total arterial revascularization versus MAG with ≥1 supplementary vein grafts. At a median follow-up duration of 5.0 years postoperatively, the mortality rate was significantly lower for MAG than single arterial grafting (hazard ratio [HR], 0.79 [95% CI, 0.76-0.83]; P<0.001). The stratified MAG analysis found that MAG with total arterial revascularization had a lower risk of late death (HR, 0.85 [95% CI, 0.80-0.91]; P<0.001) compared with MAG with ≥1 supplementary vein grafts. Sensitivity analyses produced consistent outcomes as the primary analysis. Following adjustment for the presence of SVG in the Cox model, the survival advantage of incremental number of arteries was lost. Multiple arterial grafting has significantly improved long-term survival compared with single arterial grafting. A further incremental survival benefit exists when no SVG is used.

Single-Centre Registry Analysis of Patients Who Underwent Percutaneous Coronary Intervention on Their Coronary Bypass Grafts

BackgroundThe study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates. MethodsA single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI. ResultsThe median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome. ConclusionsPatients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.

Feasibility and accuracy of real-time 3D-holographic graft length measurement, a sub-study of the FAST-TRACK CABG trial

Abstract Background 3D Hologram is an emerging tool for intuitively manipulating and visualizing CT images. Mixed reality (MR) technology can display high-definition 3D holograms while preserving situational awareness. The new MR software offers the possibility to measure 3D objects using hand gestures and voice commands. However, these measurements made on 3D holograms have not been validated. Purpose We aimed to assess the feasibility and accuracy of using CT-derived 3D holograms for bypass graft length measurement. Methods Twenty-seven consecutive cases in the FAST TRACK CABG trial were included. The post-operative CT images performed at 30 days follow-up were analyzed in an independent core lab. Two analysts blinded to clinical information performed Holographic reconstruction and measurement using the CanaLife Holo software (Medapp, Krakow, Poland). (Figure 1) Inter-observer agreement was assessed in the first 20 cases. Another analyst with full access to clinical information performed the validation measurements on the CardIQ W8 system (GE Healthcare, Milwaukee, Wisconsin). (Figure 1) Results A total of 62 grafts (27 left internal mammary artery grafts, 27 saphenous vein grafts, and 8 right internal mammary artery grafts) were measured. There was an excellent inter-observer agreement between the analysts in the first 47 grafts analyzed (interclass correlation 0.9879 [0.9783-0.9933]). (Figure 2A, 2B) On average, holographic reconstruction and measurement of a case took 3 minutes and 36 seconds± 50.74 seconds compared to around 10 minutes per vessel on the traditional CT system. There was no significant difference between the graft length measured by hologram and CT (188.59±51.63 mm vs. 183.95±50.93 mm, p=0.616). The length measured by hologram and CT were similar across different graft types. The measurements of hologram and CT are highly correlated (r=0.973, p &amp;lt;0.001) with an excellent agreement (interclass correlation 0.9928 [0.9880-0.9957]). (Figure2C, 2D) Conclusion Holographic vessel length measurement is feasible, fast, and accurate even for tortuous coronary bypass grafts. This new methodology can empower surgeons to visualize and measure the results of their work by themselves and may provide insights for procedure evaluation. 3D Holograms can eventually empower surgeons to plan the precise length of the arterial and venous grafts to be harvested for every individual case.

Right ventricular dysfunction after coronary artery bypass grafting

Abstract Background Impaired right ventricular (RV) function is a frequent echocardiographic finding following coronary artery bypass grafting (CABG). It is subject of debate whether this finding reflects actual RV dysfunction with clinical impact, or rather limitations of the applied echocardiographic measurements. Purpose We aimed to investigate prevalence of RV dysfunction using currently available echocardiographic measurements, and self-reported physical capacity more than two years after CABG. Materials and methods This pre-specified cross-sectional substudy of the SWEDEGRAFT trial included patients scheduled for follow-up more than two years after elective CABG at our institution. The SWEDEGRAFT trial is an ongoing multicenter, randomized clinical trial comparing patency of saphenous vein grafts harvested with "no-touch" and open skeletonized technique. We prospectively assessed RV function with multivariable transthoracic echocardiography. Self-reported physical capacity was assessed using the three items for physical limitation of the Seattle Angina Questionnaire (SAQ-7) (3 denotes the worst and 15 the best possible physical capacity), as well as NYHA-class. Baseline and procedural data were retrieved from the SWEDEGRAFT trial. Preoperative echocardiographies were systematically reexamined. Results We enrolled 207 patients into our substudy at a median follow-up after CABG of 31.0 (range 24.2-39.9) months. RV function assessed by tricuspid annular plane systolic excursion (TAPSE) was significantly reduced compared to the preoperative assessment. In contrast, postoperative RV function as assessed by RV fractional area change (FAC) was preserved. Similarly, assessment of three-dimensional RV ejection fraction (3D-RVEF) indicated preserved RV function (mean 49.4 ± 6.3 %). Mean RV global longitudinal strain was -19.7 (±3.6), and mean RV free wall strain was -22.7 (±4.9). At follow-up, assessments of 3D-RVEF and strain modalities were obtainable in 51.7% and 72.4% of patients, respectively. Patient-reported functional capacity was excellent (median score 15, interquartile range 1.5). NYHA-class improved significantly (NYHA-class I preoperative 49.4% vs. postoperative 61.4%, p=0.032). Postoperative median pro-Brain Natiuretic Peptide levels were 163 (interquartile range 195) ng/L. Conclusion RV systolic function was preserved more than two years after CABG when assessed by RV FAC and 3D-RVEF despite significant reduction in TAPSE. These findings likely reflect the increased sphericity of the RV following opening the pericardium during surgery. Our study supports that measurements of longitudinal systolic parameters likely underestimate RV systolic function after CABG.

Abstract 15827: Impact of Harvesting Techniques on Coronary Bypass Conduit Endothelial Cells and Collagen Exposure Using Ligand-Based Targeting

Background: Coronary bypass is a mainstay therapy for coronary artery disease (CAD). Conduit options include the internal thoracic artery (ITA), radial artery (RA), and great saphenous vein (GSV). Long-term patency rates are &gt;95% (ITA), 75% (RA), and 50% (GSV) at 10 years. The impact of harvesting techniques on endothelial cells is not well understood. Hypothesis: We hypothesized that observed differences in patency rates could potentially be explained by differences in endothelial cell response to a harvesting technique. Aims: 1) Determine degree of endothelial cell damage between different conduits and various harvesting techniques. 2) Assess ability of a specific collagen binding peptide SILY to bind to exposed collagen in GSV. Methods: De-identified human graft samples of ITA, RA, and GSV were collected and analyzed from September 2021 through February 2023. The harvesting techniques were open for ITA and GSV, endoscopic for RA, and endoscopic for GSV. The samples were fixed and stained with anti-CD31 antibody to identify endothelial cells on the luminal surface with enface imaging. Binding of SILY peptide to GSV was tested at different concentrations and incubation times. Results: 51 specimens were obtained, 18 open ITA, 10 open GSV, 18 endoscopic GSV, and 5 endoscopic RA. Luminal surface covered by endothelial cells was 86.6±8.1% for ITA, 76.7±14.7% for RA, 58.3±14.0% for endoscopic GSV, and 59.0±5.5% for open GSV. Endothelial coverage area on ITA samples was significantly higher compared to endoscopic GSV, open GSV, and RA (p&lt;0.05). Endothelial coverage area on RA samples was significantly higher compared to endoscopic GSV and open GSV (p&lt;0.05). There was no statistically significant difference in endothelial coverage area between open and endoscopic GSV (p=0.43). Testing of SILY binding revealed colocalization with collagen fibers on luminal surface of GSV samples. Conclusions: Microscopic examination showed greatest preservation of endothelial cells on ITA followed by RA and GSV with no difference between open and endoscopic GSV. Targeting of exposed collagen with SILY in the areas of damaged endothelium might be a good approach for therapeutics in the future.

Abstract 14961: Revitalizing Graft Patency: Intravascular Lithotripsy in Calcified Saphenous Vein Graft to Left Anterior Descending Artery Stenosis

A 73-year-old man with coronary artery disease (CAD), coronary artery bypass graft, heart failure [EF 25%] &amp; hypertension presented with Non-ST Segment Myocardial Infarction. Angiography revealed multivessel CAD with chronic total occlusion (CTO) of mid-left anterior descending (LAD) after a large first diagonal branch, CTO of mid-left circumflex &amp; distal right coronary artery. Saphenous vein graft (SVG) to obtuse marginal was patent. SVG-diagonal &amp; SVG-ramus intermedius were occluded. Mid SVG-LAD showed severe calcified stenosis (Fig. 1A). Native LAD beyond the SVG provided left to right collaterals to right posterior descending artery. Complex high-risk coronary intervention was performed on the SVG-LAD with mechanical circulatory support (MCS; Impella CP). SVG-LAD had a balloon undilatable lesion despite high pressure inflation with 4.0 mm cutting balloon (Fig. 1B). Intravascular ultrasound (IVUS) revealed severe stenosis with extensive circumferential calcification (Fig. 1C). Subsequently, intravascular lithotripsy (IVL) with 4.0 mm Shockwave balloon followed by high pressure balloon angioplasty with 4.5 mm noncompliant (NC) balloon was performed with significant luminal gain and fractures in calcium (Fig. 1D). The lesion was treated with 5.0 mm drug eluting stents that were post dilated with 5.0 mm NC balloon with excellent angiographic and IVUS result (Figs. 1E &amp; F). MCS was successfully removed at the end of the case.SVG grafts are associated with poor long-term patency compared to arterial grafts. PCI to SVG has a high failure rate and PCI of native vessel is often preferable. High risk SVG interventions with atherectomy have been recently reported, though data is limited. IVL has been safely used in heavily calcified native coronary arteries, however, its use in SVG disease is rare. We report the first off-label use IVL of SVG-LAD with MCS for treatment of a last-remaining conduit. Additional studies to assess IVL efficacy in vein grafts are warranted.

Abstract 14977: Radial Artery Usage Rate Differs in Hospital Types in Coronary Artery Bypass Graft Surgery: An Insight Into National Inpatient Sample

Introduction: In coronary artery bypass grafting (CABG), the left internal mammary artery (LIMA) may not be utilized, and a secondary conduit is chosen to treat coronary artery disease. Radial artery (RA) and greater saphenous vein (GSV) are both viable secondary conduits to, although RA grafting is associated with higher patency and superior long-term survival. This study aimed to compare the rate of RA graft usage in CABG among different hospital types. Methods: Patients received CABG between Q4 2015-2020 were extracted from National Inpatient Sample (NIS) based on ICD10-PCS. Patients less than the age of 40 were excluded for congenital heart defects. Preoperative variables included sex, age, race and ethnicity, socioeconomic status (SES), Elixhauser comorbidities, and hospital characteristics. The rate of RA versus GSV usage were compared with respect to hospital location/teaching status and bed sizes, while all preoperative variables besides the variable of interest were adjusted by multivariable analysis. Results: There were 56,318 CABG cases identified with 11,708 RA and 44,610 GSV grafting. RA grafting usage was lower in rural hospitals (aOR 0.59, p&lt;0.01), urban private practice (aOR 0.69, p&lt;0.01), and hospitals with large bed sizes (aOR 0.91, p&lt;0.01) while the rate is higher in urban teaching hospitals (aOR 1.50, p&lt;0.01) and hospitals with medium bed sizes (aOR 1.14, p&lt;0.01). Conclusion: This study reveals different RA graft usage for CABG among different hospital types. RA harvest can be more time consuming and resource intensive than GSV harvest. Increased familiarity overcoming these obstacles might increase RA graft usage.

The VEST External Support for Saphenous Vein Grafts in Coronary Surgery: A Review of Randomized Clinical Trials.

Saphenous vein grafts (SVGs) are the most frequently used conduits in coronary artery bypass grafting (CABG), but their higher rate of occlusion compared to arterial conduits remains a concern. Previous studies have shown that SVG failure is mainly driven by intimal hyperplasia, an adaptative response to higher pressures of the arterial circulation. The VESTTM device (Vascular Graft Solutions, Tel Aviv, Israel), an external support designed to mitigate intimal hyperplasia in SVGs, has been tested in few clinical trials (RCTs). Herein, we descriptively evaluated the randomized evidence on the VEST device.

Abstract 17330: Demographic Factors Associated With Disparity in Radial Artery Usage in Coronary Artery Bypass Graft Surgery: Insights From the National Inpatient Sample

Introduction: The choice of graft for revascularization in coronary artery bypass grafting (CABG) impacts surgical outcomes. While both radial artery (RA) and greater saphenous vein (GSV) are options for secondary conduits to the left internal mammary artery (LIMA), RA graft usage is associated with better patency and better long-term survival benefit. However, equity of RA conduit usage in CABG is unknown. This study aimed to examine demographic factors associated with disparity of RA grafting among patients undergoing CABG. Methods: The National Inpatient Sample (NIS) was used to extract patients received who underwent CABG between Q4 2015-2020 based on ICD10-PCS. Patients less than the age of 40 were excluded for congenital heart defects. Preoperative variables include sex, age, race and ethnicity, socioeconomic status (SES), Elixhauser comorbidities, and hospital characteristics. The rate of RA usage with respect to race, sex, and SES was compared, respectively, while all preoperative variables besides the variable of interest were adjusted by multivariable analysis. Results: There were 56,318 CABG cases identified in the NIS with 11,708 RA and 44,610 GSV grafting. African American race (aOR 0.78, p&lt;0.01), Hispanic race (aOR 0.83, p&lt;0.01), female sex (aOR 0.53, p&lt;0.01), and lower income (0-25 percentile, aOR 0.78, p&lt;0.01; 25-50 percentile, aOR 0.95, p=0.04) were independently associated with lower rates of RA grafting usage among patients who underwent CABG. Conclusion: This study reveals disparities in RA graft usage for CABG, including racial minorities, women, and economically disadvantaged groups who were less likely to receive RA. These findings highlight the need for healthcare equity in choosing the optimal graft conduit in CABG.

Comparison of one-year outcomes and quality of life between endovenous microwave ablation and high ligation and stripping of the great saphenous vein.

The objective of this study is to evaluate and compare the effectiveness of endovenous microwave ablation (EMA) and high ligation and strippingn (HLS) of the great saphenous vein (GSV) in the treatment of varicose veins. We included 182 patients in each EMA and HLS groups. Follow-up outcomes included AVVQ, VCSS, chronic venous insufficiency questionnaire-14 (CIVIQ14) score, clinical recurrence rate of varicose vein treatment, and patient satisfaction during the 1-year follow-up period. At the 1-year follow-up, no significant difference was found in the clinical recurrence rate of varicose veins between the EMA and HLS groups (p = .75). The duration of the operation and the length of hospital stay for patients in the EMA group was shorter than that for the HLS group (p < .01). The Aberdeen Varicose Vein Questionnaire (AVVQ), Venous Clinical Severity Score (VCSS) score, and ecchymosis were lower for patients who underwent EMA surgery (p < .01). Our research results confirm that EMA improves patients' quality of life with lower limb varicose veins, with EMA showing higher patient satisfaction.

Abstract 11996: National Survey of Coronary Artery Bypass Grafting in Adult Patients With Coronary Artery Lesions Caused by Kawasaki Disease in Japan

About 50 years have passed since the first report of Kawasaki disease (KD), and adult patients with coronary artery lesions caused by KD have increased. The national results of coronary artery bypass grafting (CABG) in adult KD patients who had undergone CABG between 2008 and 2019 in the National Clinical Database of Japan were investigated. A total of 343 patients were identified. Furthermore, the outcomes of the 167 patients (49%) after discharge were surveyed by questionnaires. There were 264 male (77%) and 79 female (23%) patients. The median age at operation was 39 (5 th -95 th percentile, 13-72 years). The numbers of emergent operations was 37 (10%). Previous CABG and previous percutaneous coronary intervention were performed in 16 (5%) and 50 (15%) patients, respectively. Acute myocardial infarction was found in 64 patients (19%), and cardiogenic shock was found in 10 patients (3%). The mean numbers of grafts and anastomosed vessels were 2 each. The grafts used were as follows. internal thoracic artery 316; saphenous vein grafts 118; gastroepiploic artery 52, and radial artery 56. The anastomosed vessels were as follows. left anterior descending artery 305, right coronary artery 209, left circumflex 145, and diagonal branch 73. Mitral valve surgery and aortic valve surgery were performed in 10 and 9 patients, respectively. The coronary risk factors were as follows: Previous smoking 124 (36%), dyslipidemia 126 (37%); hypertension 124 (36%); and diabetes mellitus 35 (10%). Antiplatelet agents after CABG were administered after CABG to all patients, and coumadin was given to 133 patients (39%). Statins and beta-blockers were given to 143 (42%) and 198 patients (58%), respectively. Three patients (0.8%) died in hospital, and 7 patients died in the late period. Survival rates after CABG at 1, 5 and 10 years were 98%, 94% and 93%, respectively (n= 343). Survival rates at 5 years depending on the values of the preoperative left ventricular ejection (LVEF) were as follows. bad (&lt;30%, n=24), 72%, medium (≧30% but &lt; 60%, n=140), 93% good (≧60%, n=189), 97%. There were significant differences among the 3 groups (p&lt;0.01). The preoperative LVEF affected on the outcome after CABG.

Mesoglycan for the secondary prevention of superficial vein thrombosis: a randomized, controlled, double-blind study (METRO Study)—rationale and protocol

No data is available about pharmacological secondary prevention of superficial vein thrombosis (SVT) despite 10–15% of patients develop venous thromboembolic complications at 3–6 months after an adequate treatment of the acute phase. To verify efficacy and safety of mesoglycan in secondary prevention of SVT recurrence and venous thromboembolic complications. Phase III multicenter, double-blind, randomized, superiority trial comparing mesoglycan 50 mg bid vs placebo in consecutive patients with a SVT extended at least 5 cm, after the initial 45-day treatment course with fondaparinux 2.5 mg once-daily. Primary efficacy outcome: SVT recurrence/extension, symptomatic venous thromboembolism (VTE), asymptomatic proximal deep-vein thrombosis, death. Primary safety outcome: major bleeding. We hypothesized a 12-month 15% incidence of the primary efficacy outcome in placebo group and a 50% risk reduction in mesoglycan group. A bilateral log-rank test with a sample of 650 patients (randomization 1:1) reach a 90% power, with an α-error of 0.025, of detecting a 7.0% difference (HR = 0.51) after 12 months of treatment, considering a 10% patients drop-out. At deadline (December 31, 2022) 570 patients have been randomized (10% drop rate). Mean age was 63.9 years, 58.8% were women. SVT involved great saphenous vein in 69.3%, small saphenous vein in 13.1%, and collaterals in 17.6% of patients. SVT was the first event in 61.7%, a recurrence in 38.3%, provoked in 50.2% and unprovoked in 49.8%. Patients not experiencing a primary outcome, or not retiring their consent will be followed up to December 31, 2024 when the final data analysis will be performedClinicalTrials.gov: NCT03428711.

Evaluating endovenous laser and glue ablation in the treatment of great saphenous vein insufficiency: A 5-year retrospective comparative study

Aim: The use of endovascular thermal and nonthermal methods in the treatment of chronic venous insufficiency has been in practice for over 10 years. The early results of these practices have been published and extensively discussed. Medium and long-term results are now being announced. In our study, we discussed the results of endovenous laser ablation and endovenous glue ablation methods, along with hemodynamic evaluations. Material and Methods: Doppler USG and Digital Photo Plethysmography were used to examine patients with chronic venous insufficiency in the C2-5 group who received endovenous ablation indication. Records of VCSS and CIVIQ-20 were obtained. Measurements were taken at 1, 3, 6, 12, 24, and 60 months. Procedural and post-procedural variables were compared, and the results were obtained for a 5-year period. Results: The demographic profiles of the groups were similar. The duration of the procedure was significantly longer in the EVLA group. Similarly, the pain during the procedure was statistically significantly higher in the EVLA group. Venous refill time and venous half-life time showed a statistically significant improvement in both groups. While there were close to 100% closure rates in both groups during the first 6 months, the rates decreased to 95.2% in EVLA and 93.5% in EVGA by the end of the fifth year. Conclusion: With 5 years of objective and subjective findings, both EVLA and EVGA are effective and reliable methods with their advantages and disadvantages. However, EVGA may be more preferred by patients because it does not require tumescent anesthesia, causes less pain, and has a shorter procedure time.

Transected popliteal artery via gunshot wound: A case report

Introduction: Popliteal artery transection is an uncommon injury but can be seen in traumas like gunshots, stabs, and complex fractures of the distal femur or proximal tibia. Although uncommon, these injuries carry the greatest risk of limb loss of any peripheral vascular injury. Timely hemostasis and repair is crucial to limb-salvage and overall survival, as lower extremity amputation is known to have very high mortality rates. We present a multiple gunshot wound patient who was found to have a completely transected popliteal artery injury and who underwent open surgical repair with interposition vein graft using the greater saphenous vein, ultimately resulting in two-vessel runoff and limb salvage. Case Report: A 30-year-old man with no known past medical history presented to the hospital via private vehicle after being shot multiple times just prior to arrival. Obvious injuries noted were two gunshot wounds to the left hand with hemorrhage, two gunshot wounds to the right thumb without hemorrhage, one gunshot wound to the left upper quadrant, one gunshot wound to the left flank, and one to the right lower extremity in the posterior distal thigh with massive hemorrhage. He was emergently taken to the operating room where exploration of the right popliteal artery and vein was performed which revealed a completely transected popliteal artery. The bullet was found to be lodged in the distal femur. The left great saphenous vein was then harvested in order to use it to repair the right popliteal artery with an interposition vein bypass. Intraoperative angiogram confirmed 2-vessel runoff. A four-compartment fasciotomy was performed prophylactically to avoid compartment syndrome. Postoperatively, the patient was extubated on post-op day 1. On post-op day 7, he was transferred out of the ICU and underwent split thickness skin grafting to the right lower extremity fasciotomy wounds. On post-op day 18, he was discharged home with a walker and the ability to move all extremities. He has now recovered full ambulatory function. Conclusion: Transection of popliteal artery should be considered in trauma patients with profuse lower extremity bleeding. In severe injuries and hemodynamically unstable patients, prompt hemostasis should be achieved and open surgical repair with an interposition vein graft should be considered for limb salvage.