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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
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Management and Prevention of Saphenous Vein Graft Failure: A Review

Peter McKavanagh1, Bobby Yanagawa2, George Zawadowski2

  • 1Terrence Donnelly Heart Center, Divisions of Cardiology and Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada. mckavanagh@doctors.net.uk.

Cardiology and Therapy
|July 28, 2017
PubMed

Insights

Coronary artery bypass grafting (CABG) using saphenous vein grafts (SVG) is crucial for multivessel coronary artery disease (CAD). This review details SVG failure, its causes, and prevention strategies to improve long-term patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Biomedical Engineering

Background:

  • Coronary artery bypass grafting (CABG) is essential for multivessel coronary artery disease (CAD), particularly in diabetic patients.
  • Internal thoracic artery grafts offer superior long-term patency and are the gold standard for severe CAD revascularization.
  • Saphenous vein grafts (SVG) are frequently used for complete revascularization but exhibit limited longevity and are linked to adverse cardiac events.

Purpose of the Study:

  • To review the pathogenesis of saphenous vein graft (SVG) failure in coronary artery bypass grafting (CABG).
  • To differentiate between early, intermediate, and late phases of SVG failure.
  • To explore surgical techniques, medical management, and percutaneous interventions impacting SVG failure.

Main Methods:

  • Literature review of studies on SVG failure in CABG.
  • Analysis of factors contributing to early, intermediate, and late graft occlusion.
  • Examination of current prevention and treatment strategies for SVG failure.

Main Results:

  • SVG failure is multifactorial, influenced by intrinsic graft properties and surgical technique.
  • Early failure is often due to technical issues, while late failure involves atherosclerosis and intimal hyperplasia.
  • Medical and interventional therapies show promise in mitigating SVG failure.

Conclusions:

  • Understanding SVG failure mechanisms is critical for improving CABG outcomes.
  • Optimizing surgical techniques and employing contemporary medical/interventional strategies can enhance graft patency.
  • Further research is needed to refine prevention and treatment of SVG failure for long-term cardiac health.

Keywords:
AnticoagulationAntiplateletGraft failureSaphenous vein graft

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