Restenosis in Saphenous Vein Grafts

The growing population of patients with aged saphenous vein grafts has become a clinical challenge of increasing magnitude. Efforts to treat these patients with transcatheter interventions have been limited by distal embolization and restenosis. The use of intravascular stents has been a major breakthrough in improving the short- and long-term clinical outcomes of such patients. Future techniques, which promise to reduce in-stent restenosis and improve long-term outcomes, include the use of drug-coated stents and brachytherapy. This article reviews the percutaneous approach to the patient with vein graft disease, focusing on issues pertaining to the pathophysiology, prevention, and treatment of restenosis.