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Updated: Dec 5, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Current role of saphenous vein graft in coronary artery bypass grafting
Sajjad Raza1, Carolyn Chang2, Salil Vasudeo Deo1
1Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH 44106-7060 USA.
Insights
Saphenous vein grafts are common in coronary artery bypass grafting (CABG) but have limitations. Arterial grafts offer better patency, though saphenous vein grafts remain crucial for specific patient groups and arterial conditions.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease
Background:
- Saphenous vein grafts (SVG) were historically the primary conduit for coronary artery bypass grafting (CABG).
- Despite widespread use, SVG durability and long-term patency are suboptimal compared to arterial grafts.
- Arterial conduits demonstrate superior patency rates, making them a preferred choice in many CABG procedures.
Purpose of the Study:
- To compare the efficacy and suitability of saphenous vein grafts versus arterial grafts in coronary artery bypass grafting.
- To identify specific clinical scenarios and patient populations where saphenous vein grafting remains the optimal choice.
Main Methods:
- Review of existing literature and clinical data comparing SVG and arterial graft outcomes in CABG.
- Analysis of graft patency, durability, and patient survival rates based on conduit type.
- Evaluation of specific indications for SVG use, including graft target vessel characteristics and patient comorbidities.
Main Results:
- Arterial grafts generally exhibit better long-term patency than saphenous vein grafts in CABG.
- Saphenous vein grafts may be preferable in cases of right coronary artery grafting with specific stenosis degrees and competitive flow.
- SVG use is also indicated in high-risk patients for wound infections and in octogenarians where arterial grafting poses increased risks.
Conclusions:
- While arterial grafts are preferred for their superior patency, saphenous vein grafts remain a valuable and necessary option in select CABG scenarios.
- Patient-specific factors and target vessel characteristics dictate the optimal choice of bypass conduit.
- Further research may refine guidelines for conduit selection in complex CABG cases.
Abstract:
Saphenous vein was the conduit used in the first series of coronary artery bypass grafting (CABG), and, with the exception of surgical revascularization of the left anterior descending artery, it remains the most commonly used bypass conduit. However, its durability and longevity are not ideal. Arterial grafts have better patency than saphenous vein grafts and therefore should be preferred over them. However, in certain situations, like grafting right coronary arteries with lesser degree of proximal stenosis and higher competitive flow, or in certain patient populations, like those at very high risk of wound infections and octogenarians, arterial grafting may not be the best option and saphenous vein grafting should be considered instead.
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