EVERE TRAUMATIC BRAIN INJURY (TBI) is common in patients with major trauma and typically involves young adult men. 1 Despite current management strategies, patients with severe TBI have a high mortality rate (31%-49%) and a large number of survivors have persistent severe neurological disability. 1-4 There are 80000 to 90 000 were cases of survivors with long-term disability after head injury annually in the United States. 5 The mean lifetime cost of each TBI survivor with severe disability from TBI exceeds US $2 million. 6 After initial head trauma, secondary brain injury may occur due to hypoxia, hypotension, or elevated intracranial pressure (ICP) and is associated with a worse neurological outcome. 3,7 Patients with hypotension after severe TBI have twice the mortality rate of normotensive patients. 5 Therefore, aggressive resuscitation with intravenous fluids is recommended in current guidelines for the management of patients with severe TBI. 8 Treatment of increased ICP in patients with TBI is also likely to improve outcomes. 3

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thoracic stent grafts can be performed with low morbidity and mortality. They offer a realistic alternative to open surgery. Long term follow up is required to assess their durability.

Poor long-term patency of saphenous vein grafts limits the long-term success of the coronary artery bypass operation. If this is to be improved, either measures that increase the patency of saphenous vein grafts or alternative conduits are required. The benefits of using the left internal mammary artery as a pedicled graft to the left anterior descending coronary artery have prompted increasing use of arterial grafts to further improve outcome. Concurrently advances in the understanding of the pathological processes underlying saphenous vein graft occlusion raise the possibility of improving vein graft patency. In this paper we review the problem of vein graft occlusion and possible solutions, the theoretical benefits of arterial grafts and the clinical results associated with their use.

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