VEST external stent for coronary artery bypass grafts

The technology described in this briefing is the venous external support, or VEST, a kink-resistant external stent for saphenous vein grafts used during coronary artery bypass graft (CABG) surgery.

The innovative aspects are that it is the only available device which externally supports vein grafts. This aims to preserve graft patency and reduce the need for reintervention.

The intended place in therapy would be as an adjunct to standard CABG surgery, during which vein graft support devices are not currently used.

The main points from the evidence summarised in this briefing are from 2 published studies and 2 published sub-analyses involving a total of 60 people having CABG. These show some improvements in proxy outcomes but no differences in graft failure rate when compared with unstented grafts.

Key uncertainties are that the evidence base is still developing, with no direct comparison of patients having CABG with or without VEST for more than 12 months.

The cost of VEST is £700 per unit (exclusive of VAT). The resource impact is that VEST may increase costs compared with standard care because of the additional cost of the stent, depending on the number of vein grafts used. This could be offset if further evidence confirms a reduced reintervention rate.