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Updated: Jun 10, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Consensus statement-graft treatment in cardiovascular bypass graft surgery
Maximilian Y Emmert1,2, Johannes Bonatti3, Etem Caliskan1
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
Insights
Coronary artery bypass grafting (CABG) uses saphenous vein grafts (SVG) but faces patency issues due to intimal hyperplasia. Novel techniques and arterial grafts aim to improve long-term CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Innovation
Background:
- Coronary artery bypass grafting (CABG) is the primary revascularization strategy for multivessel disease.
- Saphenous vein grafts (SVG) and internal mammary arteries are standard CABG grafts, but SVG long-term patency remains a concern.
- Intimal hyperplasia, driven by shear forces and inflammation, limits SVG durability despite early reendothelialization.
Purpose of the Study:
- To review and standardize graft treatment strategies for coronary artery bypass grafting (CABG).
- To address the limitations of saphenous vein graft (SVG) patency in CABG surgery.
- To explore alternative and advanced techniques for improving CABG outcomes.
Main Methods:
- Discussion of "No-Touch" harvesting, graft storage solutions, flushing, and external stenting to mitigate intimal hyperplasia.
- Exploration of arterial grafts for total arterial revascularization in CABG.
- Consideration of composite grafting, pharmacological agents, and minimally invasive techniques.
Main Results:
- Established methods like "No-Touch" harvesting aim to improve SVG patency but are not universally adopted.
- Arterial grafts offer a strategy to overcome SVG limitations and achieve total arterial revascularization.
- Various innovative approaches are being developed to enhance graft performance in CABG.
Conclusions:
- Optimizing graft selection and treatment is crucial for improving CABG patient outcomes.
- Despite challenges, continuous innovation in graft management is essential for advancing CABG surgery.
- Standardization of best practices in graft handling and utilization is needed for consistent CABG success.
Abstract:
Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. "No-Touch" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.
