Exostents de injertos de vena safena: revisión bibliográfica y metaanálisis de efectividad

Abstract

Saphenous vein grafts (SVI) are the most common conduits used in revascularization surgery. However, its failure rate is 35-50% at 5-10 years, partially due to intimal hyperplasia secondary to shear wall stress. Different exostents have been developed in order to amend this effect. A systematic review was performed in Pubmed with different combinations of keywords to identify all studies about the use of exostents. Two meta-analyses were performed, one based on the patency of the grafts and another focused on the development of pathological intimal hyperplasia, corresponding to grades II-III of the Fitzgibbon classification. An update of the evidence was carried out regarding the 5 exostents already available. Ten controlled comparative studies were selected for the meta-analyses. The use of exostents was detrimental in terms of patency (RR: 1.67; P = .03). However, in the subgroup analysis, the VEST® devices did not show significant differences compared to the control group (RR: 1.11; P = .59). Furthermore, these devices allowed maintaining more grafts in grade I of intimal hyperplasia, compared to unsupported grafts (RR: 0.53; P = .02). To conclude, exostents, globally considered, do not improve IVS patency in the mid-short term follow-up. However, some devices such as VEST®, have shown to limit the development of intimal hyperplasia, which may improve graft patency in the extension of the follow-up of ongoing studies.