Saphenous vein graft intervention: status report 2014

Given their frequent use as bypass conduits and high rates of degeneration, saphenous vein grafts (SVGs) will continue to require percutaneous coronary intervention. Due to their unique physiology, SVGs pose special challenges to the interventionalist. Preintervention evaluation of hemodynamic significance is hampered by limited data and uncertainty regarding the validity of fractional flow reserve. Intraprocedural complications, particularly distal embolization and no-reflow, are common but may be mitigated by various techniques. Despite advances in the field, SVG intervention is associated with worse outcomes - including increased rates of periprocedural myocardial infarction, restenosis, target vessel revascularization, non-target disease progression, and death - compared with native vessel intervention. This paper reviews the most recent data and techniques available to the interventionalist seeking to improve outcomes after SVG intervention.