The role of vein grafts in coronary surgery

Abstract

BACKGROUND: Coronary artery bypass grafting (CABG) is a cornerstone of invasive treatment of coronary artery disease. Despite the frequent use of arterial conduits saphenous veins remain important grafts (SVG). METHODS: Review of literature on SVG. RESULTS: SVG are surgically attractive to handle (e.g. to serve for plaque bridging arteriotomies, anastomoses to vascular prostheses). However vein graft disease limits the longevity of SVG, which results in occlusion rates of 40–50% after 10 years. The injury of vein grafts starts with surgical harvesting and exposure to a varying ischemic time. After arterialisation the (thin walled) vein is exposed to systemic blood pressures. Hence surgical handling using a no-touch technique is the first step towards preserving the integrity of the vein graft. Postoperative care of CABG patients is highly important, too. Postoperative therapy with aspirin and statin is standard. In addition, blood pressure and diabetes have to be closely controlled. CONCLUSIONS: Intraoperative surgical handling and postoperative patient care are important factors that influence the outcome of saphenous vein graft bypass operations.