title: A prospective study of external stenting of saphenous vein grafts to the right coronary artery: the VEST II study.
abstract: OBJECTIVE
  External stents significantly reduce intimal hyperplasia and improve lumen uniformity and flow pattern in saphenous vein grafts (SVG) 1 year after coronary artery bypass grafting. However, recent studies have shown that at 1 year there is a lower patency of externally stented SVG to the right coronary artery (RCA) (55-60%) when compared to the left sided coronary arteries (85-90%). In the current study, we investigated whether avoidance of both fixation of the external stent to the anastomoses and the use of metal clips to ligate SVG side branches would improve the early patency of externally stented SVG to the RCA.
  
  
  METHODS
  Thirty patients received a SVG to the right territory supported with an external stent. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG patency assessed by computed tomography angiography (CTA) at 3-6 months. Graft failure was defined as > 50% stenosis.
  
  
  RESULTS
  Twenty-nine patients (96.6%) completed the follow up period and CT angiography data was available for a total of 43 SVGs, (29 supported and 14 unsupported SVGs) and 47 arterial grafts. Patency of stented SVGs was 86.2% (25/29 on CTA). All non-stented SVGs to the left territory were patent. Patency rates of the left internal mammary arteries and right internal mammary arteries grafts were 96.6% and 83.3%, respectively.
  
  
  CONCLUSIONS
  Avoidance of both metallic clips to ligate side branches and of fixation of venous external support trial (VEST) stents to the anastomoses mark a significant improvement in patency of stented SVG to the right coronary territory.
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Amin
authors.affiliation: Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Djordjevic
authors.affiliation: Department of Cardiovascular Medicine, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Evangelos K
authors.initials: EK
authors.lastname: Oikonomou
authors.affiliation: Department of Cardiovascular Medicine, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Sheena
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, UK.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Kampoli
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Department of Cardiovascular Medicine, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Nikant
authors.initials: N
authors.lastname: Sabharwal
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Department of Cardiovascular Medicine, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Antoniades
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
authors.forename: George
authors.initials: G
authors.lastname: Krasopoulos
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery / Q000637:transplantation; D015607:Stents; D014654:Vascular Patency
keywords: CT angiography; Coronary artery bypass surgery; External stenting; Graft patency