Saphenous vein graft disease: review of pathophysiology, prevention, and treatment

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Francis Y Kim1, Gregary Marhefka, Nicholas J Ruggiero

  • 1Jefferson Coordinating Center for Clinical Research, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Cardiology in Review
|September 13, 2012
PubMed

Insights

Saphenous vein graft disease, a major cause of graft failure after coronary artery bypass grafting, involves thrombosis, intimal hyperplasia, and atherosclerosis. Aspirin and statins are key medical treatments to improve graft patency.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Biology
  • Pharmacology

Background:

  • Saphenous vein graft (SVG) disease is a significant cause of graft failure post-coronary artery bypass grafting (CABG).
  • The disease progresses through three distinct phases: early thrombosis, followed by intimal hyperplasia, and later atherosclerosis.
  • Endothelial damage is the primary underlying mechanism driving SVG disease development.

Purpose of the Study:

  • To review the pathogenesis of SVG disease.
  • To identify predictors of SVG failure.
  • To discuss current and potential future therapeutic strategies for managing SVG disease.

Main Methods:

  • Literature review of studies on SVG disease.
  • Analysis of surgical techniques impacting SVG patency.
  • Evaluation of pharmacologic interventions, including aspirin and statins.

Main Results:

  • SVG disease manifests in phases: thrombosis (first month), intimal hyperplasia (1-12 months), and atherosclerosis (>12 months).
  • Surgical vein harvesting techniques influence graft patency.
  • Aspirin and statins are guideline-recommended medications improving SVG patency.

Conclusions:

  • Despite advances, SVG disease significantly impacts long-term graft patency (10-year patency ~61%).
  • Understanding SVG disease pathogenesis is crucial for developing effective treatments.
  • Further research into novel surgical and pharmacologic therapies is warranted.

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