Autogenous Vein grafts

Saphenous vein grafts and their patency
Coronary artery bypass with vein grafts has been practiced for the past few decades and it has been an effective therapy for the ischemic heart disease. The long term results of bypass are compromised by the vein graft atherosclerosis and native artery atherosclerosis. In some studies it was found that 20% of the vein grafts are occluded in the first year after bypass. It was said that after 10 years only 60% of the vein grafts remain patent. Of the remaining patent grafts 50% would show a important stenosis in them. That means patients who have undergone CABG with vein grafts continue to be at risk of subsequent ischemic events as the time passes and therefore it becomes necessary to attend the risk factors more carefully with or without bypass. Though the arterial grafts gained the attention the saphenous vein remains the most commonly used conduit in many cardiac centers because of its ease of use and ready availability. Probably this holds good for the vein grafts in the leg bypass operations also.

Smoking and drug therapies

Smoking and Cytisine
Smoking is a common problem in peripheral vascular disease patients in India. Behavioural therapy programs are not popular in Indian medical practice. Most of the time it is the doctor who tells patients and at times threatens the patients explaining about the side effects of smoking. Rarely pharmacological intervention is asked by the patients. There is a fear that pharmaco-therapy is more expensive. Cytisine, a partial agonist that binds with high affinity to the α4β2 nicotinic acetylcholine receptor, is a low-cost treatment that may be effective in aiding smoking cessation.
The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally. A randomized study is published in NEJM recently and that is supporting the role of cytisine in smoking cessation.
Pinjala R K
1st Oct 2011