Abstract
Saphenous vein graft (SVG) is the most common technique of coronary artery bypass grafting (CABG). SVG failure is a source of significant morbidity and mortality and is the bane of the technique. Despite this, SVG was used in up to 85% of CABG cases done worldwide in 2015. There is a large volume of literature on late SVG failure unlike early SVG failure. This manuscript provides further insight to the pathology and prevention of early SVG failure. Early SVG failure is defined as the inability of SVG to support the metabolic requirement of a targeted myocardium resulting in potential ischemia/infarction necessitating an intervention. The major culprits for early SVG failure are vascular endothelial damage and turbulent flow. These generate shear stress and cytokine releases that mediate processes that culminate in early thrombotic SVG occlusion; a substrate for late SVG occlusion. Prevention of early SVG occlusion depends on good surgical techniques, minimal endothelial damage to SVG, large calibre anastomosis, storage in buffered ionic solution and prompt postoperative used of pharmacologic agents like antiplatelet, ACE-inhibitors and statins. Experimental techniques like external SVG vest and gene therapy show promising initial results.
Published Version
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