Saphenous Vein Graft Wrapping by Nitinol Mesh: A Word of Caution

Abstract

Background Saphenous vein conduits are still used in a large proportion of coronary artery bypass graft (CABG) operations. A recently commercialized nitinol mesh seems to improve venous graft patency. The aim of this study was to control nitinol mesh vein graft patency in a series of isolated CABG patients by computed tomographic (CT) scan.

Methods In 25 patients (mean age: 61.0 ± 9.65 years), operated for isolated CABG, the eSVS nitinol mesh (Kips Bay Medical Inc., Minneapolis, Minnesota, United States) was used to wrap one vein graft in each patient. Nitinol mesh vein graft was used to revascularize the right coronary (4 patients; 16%), the posterior descending (18 patients; 72%), and the obtuse marginal (3 patients; 12%) arteries. CT scans were performed at 1, 6, and 12 months postoperatively.

Results The procedure was uneventful in all patients. CT controls showed an overall patency rate of 86.9, 42.7, and 34.1% at 1, 6, and 12 months, respectively. The 4 mm mesh had a significantly higher patency rate at 12 months (83.33%) than the 3.5 mm one which showed quite unsatisfactory results (20%) (p = 0.02). Patients with graft occlusion underwent stress testing which was mildly positive in two cases. One of them underwent a percutaneous revascularization.

Conclusion Despite promising early results, use of nitinol mesh for saphenous veins was disappointing in our experience. Further refinements are probably needed.

Keywords

coronary artery bypass grafts surgery - computed tomography - inflammation - systemic

• References

• 1 Deb S, Wijeysundera HC, Ko DT, Tsubota H, Hill S, Fremes SE. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. JAMA 2013; 310 (19) 2086-2095
• 2 Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg 2013; 44 (6) 978-979
• 3 Buxton BF, Ruengsakulrach P, Fuller J, Rosalion A, Reid CM, Tatoulis J. The right internal thoracic artery graft—benefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Cardiothorac Surg 2000; 18 (3) 255-261
• 4 Tatoulis J. Total arterial coronary revascularization-patient selection, stenoses, conduits, targets. Ann Cardiothorac Surg 2013; 2 (4) 499-506
• 5 Barra JA, Volant A, Leroy JP , et al. Constrictive perivenous mesh prosthesis for preservation of vein integrity. Experimental results and application for coronary bypass grafting. J Thorac Cardiovasc Surg 1986; 92 (3 Pt 1) 330-336
• 6 Kohler TR, Kirkman TR, Clowes AW. The effect of rigid external support on vein graft adaptation to the arterial circulation. J Vasc Surg 1989; 9 (2) 277-285
• 7 Zurbrügg HR, Knollmann F, Musci M , et al. The biocompound method in coronary artery bypass operations: surgical technique and 3-year patency. Ann Thorac Surg 2000; 70 (5) 1536-1540
• 8 Zilla P, Moodley L, Wolf MF , et al. Knitted nitinol represents a new generation of constrictive external vein graft meshes. J Vasc Surg 2011; 54 (5) 1439-1450
• 9 Genoni M, Odavic D, Loblein H, Dzemali O. Use of the eSVS Mesh: external vein support does not negatively impact early graft patency. Innovations (Phila) 2013; 8 (3) 211-214
• 10 Emery RW, Solien E, Jamieson SW. Implantation of the eSVS Mesh. Innovations (Phila) 2012; 7 (1) 65-67
• 11 Bland JM. Clinical measurements. In: An Introduction to Medical Statistics, 2nd ed. Oxford: Oxford University Press; 1995: 268-292
• 12 Davies MG, Hagen PO. Pathophysiology of vein graft failure: a review. Eur J Vasc Endovasc Surg 1995; 9 (1) 7-18
• 13 Moritz A, Raderer F, Magometschnigg H , et al. The use of mesh-tube-constricted dilated or varicose veins as arterial bypass conduit. Thorac Cardiovasc Surg 1992; 40 (6) 356-360
• 14 Zurbrügg HR, Hetzer R. The use of biocompound-grafts together with varicose veins. First clinical experience. J Cardiovasc Surg (Torino) 1996; 37 (6) (Suppl. 01) 143-146
• 15 Rescigno G, Angelini A, D'Alfonso A, Torracca L. Coronary graft use of a new external mesh support. Interact Cardiovasc Thorac Surg 2010; 10 (4) 645-647
• 16 Moodley L, Franz T, Human P , et al. Protective constriction of coronary vein grafts with knitted nitinol. Eur J Cardiothorac Surg 2013; 44 (1) 64-71
• 17 Schoettler J, Jussli-Melchers J, Grothusen C , et al. Highly flexible nitinol mesh to encase aortocoronary saphenous vein grafts: first clinical experiences and angiographic results nine months postoperatively. Interact Cardiovasc Thorac Surg 2011; 13 (4) 396-400
• 18 Aksut M, Koksal C, Kocamaz O , et al. Should right coronary bypass grafts be anastomosed proximal or distal to the crux? A comparison of graft patencies. Ann Thorac Cardiovasc Surg 2012; 18 (4) 331-337
• 19 Goerler H, Oppelt P, Abel U, Haverich A. Safety of the use of Tissucol Duo S in cardiovascular surgery: retrospective analysis of 2149 patients after coronary artery bypass grafting. Eur J Cardiothorac Surg 2007; 32 (4) 560-566
• 20 Kjaergard HK, Fairbrother JE. Controlled clinical studies of fibrin sealant in cardiothoracic surgery—a review. Eur J Cardiothorac Surg 1996; 10 (9) 727-733
• 21 Putters JL, Kaulesar Sukul DM, de Zeeuw GR, Bijma A, Besselink PA. Comparative cell culture effects of shape memory metal (Nitinol), nickel and titanium: a biocompatibility estimation. Eur Surg Res 1992; 24 (6) 378-382
• 22 Schmehl JM, Harder C, Wendel HP, Claussen CD, Tepe G. Silicon carbide coating of nitinol stents to increase antithrombogenic properties and reduce nickel release. Cardiovasc Revasc Med 2008; 9 (4) 255-262
• 23 Chen HL, Liu K, Meng XY, Wen XD, You QS. Local application of rapamycin inhibits vein graft restenosis in rabbits. Transplant Proc 2011; 43 (5) 2017-2021