Saphenous vein graft disease, pathophysiology, prevention, and treatment. A review of the literature

Gustavo Guida, Alex O Ward, Vito D Bruno, Sarah J George, Massimo Caputo, Gianni D Angelini*, Mustafa Zakkar

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

20 Citations (Scopus)
102 Downloads (Pure)


BACKGROUND: The saphenous vein remains the most frequently used conduit for coronary artery bypass grafting, despite reported unsatisfactory long-term patency rates. Understanding the pathophysiology of vein graft failure and attempting to improve its longevity has been a significant area of research for more than three decades. This article aims to review the current understanding of the pathophysiology and potential new intervention strategies.

METHODS: A search of three databases: MEDLINE, Web of Science, and Cochrane Library, was undertaken for the terms "pathophysiology," "prevention," and "treatment" plus the term "vein graft failure."

RESULTS: Saphenous graft failure is commonly the consequence of four different pathophysiological mechanisms, early acute thrombosis, vascular inflammation, intimal hyperplasia, and late accelerated atherosclerosis. Different methods have been proposed to inhibit or attenuate these pathological processes including modified surgical technique, topical pretreatment, external graft support, and postoperative pharmacological interventions. Once graft failure occurs, the available treatments are either surgical reintervention, angioplasty, or conservative medical management reserved for patients not eligible for either procedure.

CONCLUSION: Despite the extensive amount of research performed, the pathophysiology of saphenous vein graft is still not completely understood. Surgical and pharmacological interventions have improved early patency and different strategies for prevention seem to offer some hope in improving long-term patency.

Original languageEnglish
Number of pages8
JournalJournal of Cardiac Surgery
Early online date30 Apr 2020
Publication statusE-pub ahead of print - 30 Apr 2020

Bibliographical note

The acceptance date for this record is provisional and based upon the month of publication for the article.

Structured keywords

  • Bristol Heart Institute


  • cardiovascular pathology
  • clinical review
  • coronary artery disease


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