In this recently published secondary analysis from the within-patient randomized CTSN VEST trial the authors present several interesting findings on the association between intimal hyperplasia (IH) area and clinical measures of saphenous vein graft (SVG) disease.
Although data indicates a survival advantage for multi-arterial coronary artery bypass grafting (CABG), its widespread adoption remains limited, with saphenous veins continuing to be the predominant choice for bypass conduits globally. Nonetheless, these conduits are susceptible to progressive disease development, potentially jeopardizing the long-term clinical effectiveness of CABG surgery.
While the CTSN VEST trial evaluated the efficacy of an external graft support in limiting the development of IH at 1-year post surgery, this secondary analysis looks at the relationship between graft disease, IH and clinical events. In addition, it also investigates risk factors for graft occlusion and found that female sex, non-open vein harvesting and Pulsatility Index (PI) and Mean Flow from Transit Time Flow Measurement (TTFM) were characteristics associated with 100% occlusion.
In short, the study finds a novel relationship between IH and measures of SVG disease at the 1-year postoperative time point. It also finds that an increased burden of SVG disease was associated with increased rates of clinical events, including revascularization. The correlation between graft occlusion and clinical events highlights the importance of ensuring the grafts are well functioning at the time of surgery by performing TTFM.
