Pathophysiology and management of saphenous vein graft disease

ABSTRACT

Introduction

The saphenous vein graft (SVG) is the most used conduit in CABG. With standardization of its use as a conduit came an understanding of its accelerated atherosclerosis, known as saphenous vein graft disease (SVGD). Given its extensive use, a review of the pathophysiology and management of SVGD is important as we optimize its use.

Areas Covered

For this review, an extensive literature search was completed to identify and examine the evolution of SVG in CABG, mechanisms driving SVGD, and methods developed to prevent and manage it. This includes a review of relevant major papers and trials in this space.

Expert Opinion

Eras of evolution in SVG usage in CABG include an experimental era, era of SVG dominance in CABG, and the current era of mixed venous and arterial grafting. As SVGD was studied, the mechanisms behind it became more understood, and prevention and management methods were developed. As advances in surgical techniques and pharmacotherapy continue to reduce occurrence and severity of SVGD, long-term patency of SV grafts continues to improve and remain excellent in optimized settings. With continued innovation and improvement in operative techniques, the SVG conduit is and will remain an important player in the field of coronary bypass.

KEYWORDS:

• CABG
• graft
• patency
• saphenous
• vein

Article highlights

• The saphenous vein graft (SVG) is the conduit of choice in peripheral vascular surgery and the most frequently used conduit in coronary artery bypass surgery (CABG).

• Distinct eras of evolution in SVG usage with respect to CABG include an experimental era, an era of SVG dominance in CABG, and the current era of mixed venous and arterial grafting.

• With standardization of its use as a conduit came the realization that these grafts exhibited accelerated atherosclerosis.

• As this SVG disease was studied, the mechanisms behind it became more understood and methods were developed for prevention and management.

• As advances in surgical techniques and pharmacotherapy continue to develop and reduce the occurrence and severity of SVGD, the long-term patency of SV grafts continues to improve and remain excellent in optimized settings.

• With continued innovation and improvement in operative techniques, the use of the SVG conduit will remain a valuable choice in the field of coronary bypass.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.