External stenting of vein grafts in coronary artery bypass grating: interim results from a two centers prospective study.

BACKGROUND: previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting. METHODS: 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events. RESULTS: 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack. CONCLUSIONS: External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates. TRIAL REGISTRATION: Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).

Penetrating aortic ulcers after absorption of intramural hematoma.

We report a case of a type B aortic intramural hematoma, which rapidly expanded, with ulcer-like projections, after complete absorption of the hematoma. One month after the initial presentation, a new computed tomographic scan showed the appearance of a thin ulcer-like projection in the aortic wall. Three months later, after the patient reported a new episode of chest pain, a computed tomographic scan revealed 2 penetrating ulcers and rapid aortic dilation; the aortic hematoma had been completely absorbed. Urgent thoracic aortic replacement was undertaken. Three years postoperatively, the patient was asymptomatic, with no lesion or dilation of the aorta upon computed tomography. After an acute hematoma, the strength and structure of the aortic wall can alter rapidly. Damage and weakening of the aortic wall are caused mainly by infiltration of inflammatory cells, which have pronounced proteolytic and elastolytic activity. Due to the unstable nature of the lesion, optimal management remains controversial. In our patient, the inflammatory process led to the development of 2 aortic ulcers and aortic dilation within 3 months of the acute lesion, requiring urgent surgical intervention.