Saphenous Vein Graft Patency Research Articles

Preoperative Continuation of Aspirin Therapy May Improve Perioperative Saphenous Venous Graft Patency After Off-Pump Coronary Artery Bypass Grafting

There is limited information about the effect of preoperative continuation of aspirin therapy on perioperative graft patency in patients undergoing off-pump coronary artery bypass (OPCAB). We sought to evaluate the effect of preoperative continuation of aspirin therapy on perioperative graft patency after OPCAB. Using retrospectively collected data from 582 consecutive patients undergoing first-time isolated OPCAB by a single surgeon at Fuwai Hospital from October 2009 through September 2012, we evaluated the association between aspirin (100 mg daily) preceding OPCAB and the risk of adverse in-hospital postoperative events. The primary outcomes were in-hospital mortality and graft patency. The secondary outcome measures were hemorrhage-related outcomes (reexploration rate, blood transfusions, perioperative drainage loss). There was no death in the postoperative hospitalization period. Patients receiving preoperative continuation of aspirin therapy (n = 400) had significantly higher postoperative saphenous venous graft patency than did those not receiving preoperative aspirin [98.2% vs 96.1%, p = 0.02]. Multivariate analysis indicated that preoperative discontinuation of aspirin therapy significantly increased the risk of occlusion of saphenous venous graft (odds ratio, 2.193; 95% confidence interval, 1.023 to 4.701, p = 0.043). No significant differences between the two groups were observed in perioperative bleeding risks, including chest tube drainage, blood product transfusion, and reoperation for bleeding. This study indicates that preoperative continuation of aspirin therapy may improve perioperative saphenous vein graft patency after OPCAB without increasing the risk of perioperative bleeding.

Adropin: a new marker for predicting late saphenous vein graft disease after coronary artery bypass grafting.

Saphenous vein graft disease (SVGD), defined as an occlusion of 50% or more of the SVG excluding distal anastomotic occlusion, is an important predictor of morbidity after coronary artery bypass grafting (CABG). Late graft occlusion is a serious complication that often limits the use of the saphenous vein as a coronary bypass graft. Late graft occlusion is particularly common in old, degenerated venous grafts with advanced atherosclerotic plaques. Adropin has been implicated in the homeostatic control of metabolism. The purpose of this study was to investigate whether serum adropin levels are associated with late SVGD following CABG. Thirty-eight patients with SVGD involving at least one graft (occluded group; 14 females, 24 males) and 42 patients with a patent saphenous vein graft (patent group; 15 females, 27 males) were enrolled in this study. Venous blood samples were taken from all of the participants to measure plasma adropin levels using an enzyme-linked immunsorbent assay kit. The mean adropin level was significantly lower in the occluded group than in the patent group (3.2 ± 0.71 vs. 4.9 ± 1.51 ng/mL, p < 0.001). Multivariate regression analysis showed that the adropin level was the independent predictor of late saphenous vein graft occlusion. Adropin levels are lower in patients with late saphenous vein graft occlusion and these reduced adropin levels, together with other factors, may lead to saphenous vein graft occlusion. Larger and prospective studies are needed to determine if adropin plays a role in the pathogenesis of SVGD.

Secondhand Smoking and Matrix Metalloproteinase-2 and -9 Gene Expression in Saphenous Veins of Women Nonsmokers

Active smoking upregulated matrix metalloproteinase-2 (MMP-2) and MMP-9 gene expression in saphenous veins (SVs) before coronary operation. However, little is known about the effects of secondhand smoke (SHS), a smoking status that is more widely harmful to the general population, on MMP gene expression in SVs. Health effects of SHS were investigated mainly in nonsmokers married to smokers. Because the vast majority of women are nonsmokers in China, we had an opportunity to evaluate the relations between SHS and MMP gene expression in SVs of women patients before operation. A total of 258 woman patients were divided into three groups: control group, nonsmokers; SHS group, patients exposed to SHS until operation; active smoking group, patients who smoked a minimum of 1 package of cigarettes every day for more than 20 years. Messenger RNA and protein levels of MMP-2 and MMP-9 were analyzed. Saphenous vein graft patency after coronary operation was evaluated. The clinical backgrounds in the three groups were comparable. Compared with the control group, MMP-2 and MMP-9 gene expression was significantly increased in the SHS and active smoking groups (p<0.05). The degree of MMP gene expression changed by SHS or active smoking was comparable. A significant difference of SV graft patency was found among the three groups. An association of increased MMP gene expression with lowered SV graft patency was found in follow-up. Our data revealed that SHS had similar power as active smoking to affect MMP gene expression in SVs before operation and SV graft patency after coronary operation in women nonsmokers.

Midterm patency and risk factors for vein graft occlusion after endoscopic harvest

ObjectivesTo evaluate midterm patency of saphenous vein grafts harvested endoscopically and identify risk factors for subsequent vein graft occlusion. MethodsFifty consecutive patients undergoing coronary artery bypass surgery with venous graft harvested by endoscopic method were included in the study. Patients underwent computed tomography angiography follow-up at mean 24 months. Multivariate logistic regression was used to analyze associations between preoperative variables (age, ejection fraction, body mass index, gender, hyperlipidemia, hypertension, diabetes mellitus, smoking, number of defects per graft and target vessel stenosis) and the incidence of saphenous vein graft occlusion. ResultsOcclusion of the saphenous vein graft occurred in 7 patients (14.3%) and occlusion of the left internal mammary artery graft in 1 patient (2.3%) during the 24 months after surgery. No significant stenosis (i.e. narrowing by >50%) was found in the remaining grafts. Multivariate logistic regression found no association between preoperative variables and saphenous vein graft occlusion. ConclusionsPatency rates 2 years after endoscopic vein harvesting are comparable to those from open techniques. Our data indicated no association between preoperative variables and vein graft occlusion. These results support the use of endoscopic saphenectomy in a wide spectrum of patients undergoing coronary artery bypass surgery.

CRT-132 Under-Utilization of Statins and Aspirin Following Coronary Artery Bypass Graft Surgery

Coronary artery bypass graft (CABG) surgery is commonly performed to treat ischemic heart disease, but long term benefits are limited by patency of saphenous vein grafts. Both statin medications and aspirin hold class I indications for all post-CABG patients and should be continued indefinitely

Coronary Artery Bypass Grafting Using Side-to-Side Anastomosis with Distal End Clipping of the Saphenous Vein Graft

Although the Saphenous Vein Graft (SVG) is commonly grafted to the coronary artery with an end-to-side anastomotic technique, there is often a significant mismatch between the diameters of the SVG and the coronary artery, which may cause SVG failure. To overcome such a drawback of the standard end-to-side SVG anastomosis, we introduce a novel side-to-side anastomosis with distal end clipping of the SVG in coronary artery bypass grafting. The long-term outcome of Coronary Artery Bypass Grafting (CABG) depends predominantly on graft patency. Although an arterial graft is preferably used to improve long-term graft patency, a Saphenous Vein Graft (SVG) is also still widely used as a second bypass graft. The reported SVG patency ranging from 25% to >50% within 10 years was inferior to that of an arterial graft, despite considerable efforts to prevent SVG failure. Although the SVG is commonly grafted to the coronary artery with an end-to-side anastomotic technique, there is often a significant mismatch between the diameters of the SVG and the coronary artery, which may cause SVG failure. Moreover, the end-to-side anastomotic configuration has been reported to have an adverse effect on local hemodynamics, resulting in intimal hyperplasia in the long-term. The intimal hyperplasia, which is a major cause of late graft failure, has been shown to occur predominantly at the toe, heel, and bed of the host coronary artery around the distal anastomosis

Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study†

Neointimal hyperplasia secondary to vascular smooth muscle cell (VSMC) activation limits the long-term patency of saphenous vein grafts (SVGs). We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled 'no-touch' (NT) vs the conventional (CON) technique. Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084). Patients were randomly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other. SVG segments underwent morphometry, histological and electron microscopy assessments and transcript measurements of VSMC activation and differentiation markers. Leg wound functional recovery and harvest site complications were assessed using a quality-of-life questionnaire. A total of 17 patients (65.3 ± 7.3 years) were enrolled. SVGs harvested using the NT vs CON technique exhibited preserved intimal, medial and adventitial architecture. CON harvest was associated with greater medial Kruppel-like factor 4 transcript levels (0.26 ± 0.05 vs 0.11 ± 0.02, P < 0.05). CON samples had significantly lower medial serum response factor (0.53 ± 0.11 vs 1.44 ± 0.50, P < 0.05) and myocardin (0.59 ± 0.08 vs 1.33 ± 0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC activation and differentiation, was higher in the NT vs CON samples (1.84 ± 1.03 vs 0.50 ± 0.19, P < 0.05). Leg assessment scores were worse in the NT legs at 3 months, but similar to CON scores at 12 months. SVGs harvested using the 'NT' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting. Functional leg recovery was similar in both groups at 12 months. Larger studies are required to corroborate these findings.

Perioperative management of antiplatelet therapy

Worldwide, cardiovascular events represent the major cause of morbidity and mortality. A key role in the pathogenesis of these events is played by platelets. Interventional procedures, with placement of coronary and vascular stents, often represent the preferred therapeutic strategy. Antiplatelet medications are considered first-line therapy in preventing cardiovascular thrombotic events. A wide array of antiplatelet agents is available, each with different pharmacological properties. When patients on antiplatelet agents present for surgery, the perioperative team must design an optimal strategy to manage antiplatelet medications. Each patient is stratified according to risk of developing a cardiovascular thrombotic event and inherent risk of surgical bleeding. After risk stratification analysis, various therapeutic pathways include continuing or discontinuing all antiplatelet agents or maintaining one antiplatelet agent and discontinuing the other. This review focuses on the pharmacological and pharmacokinetic properties of both older and novel antiplatelet drugs, and reviews current literature and guidelines addressing options for perioperative antiplatelet management.

Remote Targets for Right Coronary Artery Bypass: Distal Trunk or Posterior Descending Artery Grafting

Choosing a good anastomotic site is crucial during surgical revascularization of the right coronary artery (RCA) system. In many instances of distal and/or sequential main trunk disease, either the right posterior descending coronary artery (RPDA) or distal part of the right main coronary artery (DRCA) is preferred as the target vessel. In this article, the saphenous vein graft (SVG) patency is compared between these two main targets in the long term. Postoperative control coronary angiograms were obtained and assessed from 452 patients undergoing conventional on-pump coronary artery bypass grafting with either a DRCA (n = 305) or a RPDA graft (n = 147) after an average postoperative period of 5.8 ± 4.3 years (range: 2 months-20 years; a total of 2,627 patient-years). The overall graft patency was 60%. The 15-year patency rate was better for the DRCA grafts than that for the RPDA grafts (32 ± 5% vs. 19 ± 6%, respectively; p = 0.001), irrespective of target vessel caliber. Other factors adversely influencing the long-term graft patency were poor target vessel quality (p = 0.002) and hypercholesterolemia (p = 0.01). On the other hand, target vessel diameter, diabetes mellitus, hypertension, chronic renal insufficiency, obesity, peripheral arterial disease, or SVG quality were not associated with poor long-term graft patency in these patients having distal-type RCA disease. In the presence of distal and/or sequential right coronary disease, DRCA may be the target vessel of choice for bypass grafting, rather than the RPDA, mainly for better long-term SVG patency rates in this location.

Association between Plasma Fibrinogen Level and Saphenous Vein Graft Patency

PP-278 Fibrinogen is related to pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in plasma fibrinogen level. Therefore, in this study we purposed to investigate whether plasma fibrinogen is associated with the patency of saphenous vein graft in

MRI-Induced Stent Dislodgment Soon After Left Main Coronary Artery Stenting

Several studies have shown the safety of MRI after coronary stenting; however, few of them included patients soon after stenting. In this report, we describe a case of MRI-induced stent dislodgment from left main coronary artery (LMCA) 2 weeks after stenting. A 56-year-old woman underwent coronary angiography for recurrence of angina 12 months after coronary artery bypass graft surgery. Coronary artery bypass graft surgery had been performed with left internal mammary artery grafted to left anterior descending artery and a saphenous vein graft to obtuse marginal branch for LMCA stenosis (Figure 1). The comorbidities of patient included hypertension, dyslipidemia, diabetes mellitus, and prior neurosurgery for a pituitary adenoma. The repeat angiogram showed known stenosis in LMCA, nonobstructive disease of left anterior descending artery and right coronary artery, patent saphenous vein graft to obtuse marginal branch, and an occluded left internal mammary artery (Figure 2). After discussion, stenting of the LMCA with a 3.5×8 mm drug-eluting stent (Cypher; Cordis Corp, Markham, Ontario) was deployed after predilatation under intravascular ultrasound guidance (Figure 3). Figure 1. Baseline coronary angiography. Baseline coronary angiography showing a significant and eccentric left main coronary artery (LMCA) stenosis ( A ) that …

Pedicled 'No-Touch' Saphenous Vein Graft Harvest Limits Vascular Smooth Muscle Cell Activation - the Patent Svg Study (NCT01488084)

Neointimal hyperplasia secondary to vascular smooth muscle cell (VSMC) activation limits the long term patency of saphenous vein grafts (SVGs). We hypothesized that SVG harvest using the pedicled “no-touch” (NT) vs. the conventional (CON) technique will be associated with morphological and molecular properties consistent with decreased VSMC activation. This may partially account for the improved patency rates noted. We also postulated that there would be no clinically important difference in the incidence and severity of SVG harvesting site complications or functional recovery at 1-year post-coronary artery bypass graft (CABG) surgery.

Predictive Factors of Late Venous Aortocoronary Graft Failure: Ultrastructural Studies

BackgroundVenous aortocoronary graft arterialization may precede a preterm occlusion in some coronary artery bypass grafting (CABG) patients. The aim of the present study was to identify ultrastructural variations in the saphenous vein wall that may have an impact on the development of venous graft disease in CABG patients.MethodsThe study involved 365 consecutive patients with a mean age of 62.9±9.4 years who underwent isolated CABG. The thickness and area of the whole venous wall, the tunica intima, the tunica media and the adventitia and the number and shape (length, thickness and length/thickness ratio) of the nuclei in the medial smooth muscle cells nuclei in the distal saphenous vein segments were evaluated by ultrastructural studies. Patients were followed up for 41 to 50 months (mean 45.1±5.1). Saphenous vein graft patency was assessed by follow-up coronary angiography. Logistic regression models were used to identify independent risk factors for late graft failure.ResultsIn 71 patients significant lesions in the saphenous vein grafts were observed. The whole venous wall thickness (437.5 µm vs. 405.5 µm), tunica media thickness (257.2 µm vs. 211.5 µm), whole venous wall area (2.23 mm2 vs. 2.02 mm2) and tunica media area (1.09 mm2 vs. 0.93 mm2) were significantly larger for this group of patients than for those without graft disease. In the latter group more elongated smooth muscle cell nuclei (higher length/thickness ratio) were found in the tunica media of the saphenous vein segments. Thickening of the saphenous vein tunica media and chunky smooth muscle cell nuclei were identified as independent risk factors for graft disease development.ConclusionsSaphenous vein tunica media hypertrophy (resulting in wall thickening) and chunky smooth muscle cell nuclei might predict the development of venous graft disease.

Neutrophil–Lymphocyte Ratio is a Predictor of Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Surgery

We read the article ‘‘Preoperative Neutrophil–Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting’’ by Tasoglu et al. They aimed to investigate the predictive value of preoperative neutrophil–lymphocyte (N/L) ratio in postoperative saphenous vein graft (SVG) patency in patients undergoing coronary artery bypass grafting (CABG) surgery. They showed that the N/L ratio is a powerful and independent predictor of further SVG failure after CABG. Patients in the highest tertile of N/L ratio were at greater risk. The study is successful in planning and presenting the results. We believe that these findings will enlighten further studies about the postoperative SVG patency and the N/L ratio. Thanks to the authors for their contribution Coronary lesion severity should be examined using both anatomical and physiological myocardial ischemia methods. Although coronary angiography is the conventional gold standard anatomical evaluation method, intravascular ultrasound and optical coherence tomography give useful information about the severity of coronary artery stenosis. Additionally, fractional flow reserve value has also become a necessary tool for the functional severity of coronary artery stenosis recently. All of these methods should be used together to evaluate the severity of coronary artery stenosis. Routine peripheral blood counts may be helpful in patients with postoperative SVG patency undergoing CABG surgery. White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. Although WBC is in the normal range, subtypes of WBC like N/L ratio may predict cardiovascular mortality. The N/L ratio is a readily measurable laboratory marker used to evaluate systemic inflammation. Because of uncontrolled hypertension, uncontrolled diabetes mellitus, metabolic syndrome, left ventricular dysfunction or hypertrophy, acute coronary syndromes, valvular heart disease, congenital heart disease, abnormal thyroid function tests, renal or hepatic dysfunction, known malignancy, local or systemic infection, previous history of infection (<3 months), inflammatory diseases, and any medication related to inflammatory condition of patients, the measurement of N/L ratio can be potentially affected in all of the above conditions. For these reasons, it would be better if the authors had mentioned these factors. Finally, not only the N/L ratio but also the mean platelet volume, red cell distribution width, uric acid, a g-glutamyl transferase, and carotid intima–media thickness are easy methods to assess the SVG patency in patients with CABG. These markers might be useful in clinical practice. In conclusion, we strongly believe that those findings obtained from the current study will lead to further large-scale studies examining the relationship between the N/L ratio and the SVG patency in patients with CABG. However, one should keep in mind that the N/L ratio alone without other inflammatory markers may not give exact information to clinicians about the inflammatory status and SVG patency of the patients. So, from that point of view we think that it should be evaluated accompanied with other serum inflammatory markers.

The No-Touch Saphenous Vein as the Preferred Second Conduit for Coronary Artery Bypass Grafting

Injury incurred while saphenous veins are being obtained results in poor graft patency and impairs the results of coronary artery bypass grafting. A novel method of obtaining veins, the no-touch technique, has shown improved long-term saphenous vein graft patency. This randomized trial included 108 patients undergoing coronary artery bypass grafting and compared the patency of no-touch saphenous vein with that of radial artery grafts. Each patient was assigned to receive one no-touch saphenous vein and one radial artery graft to either the left or the right coronary territory to complement the left internal thoracic artery. Angiography was performed in 99 patients (92%) at a mean of 36 months postoperatively. Graft and grafted coronary artery patency was evaluated. The patency of grafts for no-touch saphenous vein and radial artery was 94% versus 82% (p = 0.01), respectively. The patency of coronary arteries grafted with no-touch saphenous vein and radial artery grafts was 95% versus 84% (p = 0.005), respectively. Eighty-nine of 96 (93%) left internal thoracic artery grafts were patent. No-touch saphenous vein grafts showed a significantly higher patency rate than the radial artery grafts and the patency was comparable to the patency for left internal thoracic artery grafts. This highlights the improvement in saphenous vein graft quality with the no-touch technique and increases the number of situations in which saphenous veins may be preferable to radial artery grafts as conduits in coronary artery bypass grafting.

Expandable external support device to improve Saphenous Vein Graft Patency after CABG

ObjectivesLow patency rates of saphenous vein grafts remain a major predicament in surgical revascularization. We examined a novel expandable external support device designed to mitigate causative factors for early and late graft failure.MethodsFor this study, fourteen adult sheep underwent cardiac revascularization using two vein grafts for each; one to the LAD and the other to the obtuse marginal artery. One graft was supported with the device while the other served as a control. Target vessel was alternated between consecutive cases. The animals underwent immediate and late angiography and were then sacrificed for histopathologic evaluation.ResultsOf the fourteen animals studied, three died peri-operatively (unrelated to device implanted), and ten survived the follow-up period. Among surviving animals, three grafts were thrombosed and one was occluded, all in the control group (p = 0.043). Quantitative angiographic evaluation revealed no difference between groups in immediate level of graft uniformity, with a coefficient-of-variance (CV%) of 7.39 in control versus 5.07 in the supported grafts, p = 0.082. At 12 weeks, there was a significant non-uniformity in the control grafts versus the supported grafts (CV = 22.12 versus 3.01, p < 0.002). In histopathologic evaluation, mean intimal area of the supported grafts was significantly lower than in the control grafts (11.2 mm^2 versus 23.1 mm^2 p < 0.02).ConclusionsThe expandable SVG external support system was found to be efficacious in reducing SVG’s non-uniform dilatation and neointimal formation in an animal model early after CABG. This novel technology may have the potential to improve SVG patency rates after surgical myocardial revascularization.

Use of the eSVS Mesh: External Vein Support Does Not Negatively Impact Early Graft Patency

The aim of this study was to assess early graft patency in eSVS Mesh-covered saphenous vein grafts (SVGs) in patients undergoing coronary artery bypass grafting. In 20 patients meeting criteria for double arterial grafting to the left-sided coronary system and eSVS Mesh-covered SVG to the right-sided coronary system, patency was evaluated intraoperatively by transit time flow measurement and at 5 days postoperatively by computed tomographic angiography. Twenty patients underwent 49 arterial and 22 venous grafts (mean, 3.55/patient) using off-pump techniques. All grafts were determined to be patent intraoperatively. On computed tomographic angiography, arterial graft patency was 100%. In one venous anastomosis, the distal limb of a sequential graft was occluded, for an overall patency rate of 95%. The eSVS Mesh does not compromise early SVG patency.

Plateletcrit

Saphenous vein graft disease (SVGD) after by-pass surgery is an important cause of morbidity and mortality for patients with coronary artery disease. Comprehensive evaluation of biochemical and hematological parameters associated with this problem is limited. Plateletcrit (PCT) provides complete information on total platelet mass, but it has not been previously studied. In this study, we examined the relationship between SVGD and platelet parameters such as PCT, mean platelet volume, platelet count, and platelet distribution. We retrospectively analyzed 14,398patients who underwent coronary angiography between February 2006 and August 2012. Records from 893patients with previous coronary artery by-pass graft operation were re-evaluated. A total of 251cases were divided into two groups (127patients receiving a saphenous vein graft; 124patients diagnosed with SVGD) and hematological and biochemical parameters were compared. There were no significant differences in clinical characteristics between the two groups except that the SVGD group had a higher median time from surgery to coronary angiography than the patent saphenous vein graft group [7years (2-16) vs. 5years (2-15), p < 0.001]. The SVGD groups also had significantly higher median PCT, mean platelet volume, platelet count, uric acid level, and red blood cell distribution width. The cut-off value for PCT was found to be 0.188 for predicting SVGD, with an 80.65 % sensitivity and 81.1 % specificity. Plateletcrit has an important predictive value for SVGD, and it could be used as a marker for anti-platelet therapy to prevent graft atherosclerosis in patients undergoing by-pass surgery.

Preoperative Neutrophil–Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting

The aim of the present study was to investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) in postoperative saphenous vein graft patency in patients undergoing coronary artery bypass grafting (CABG) surgery. We retrospectively analyzed 444 patients who had undergone CABG and a further control coronary angiography due to recurrence of symptoms. The patients were divided into tertile groups according to the NLR. The primary end point was 50% saphenous vein graft stenosis or more or complete occlusion. The saphenous vein graft failure in the 3 groups based on NLR was 33%, 66.2%, and 79.1%, in the low-, middle- and high-risk groups, respectively. In multivariate regression modeling, current smoker, diabetes mellitus, target artery diameter <1.5 mm, and NLR independently predicted saphenous vein graft patency in patients after CABG. Preoperative NLR is clearly an independent predictor of saphenous vein graft patency in patients after CABG.

Saphenous Vein Graft Disease

Saphenous vein graft (SVG) disease after coronary artery bypass grafting (CABG) occurs in three phases: thrombosis, intimal hyperplasia, and atherosclerosis. Within the first month, thrombosis plays a major role. From month 1 to month 12, intimal hyperplasia occurs. Beyond 12 months, atherosclerosis becomes the primary cause for late graft failure. Endothelial damage has been shown to be the major underlying pathophysiology of SVG disease. Many factors contribute to endothelial damage from the moment the vein is harvested to when the vein is grafted into an arterial environment. To address this disease process, various therapeutic modalities, from surgical methods to medical treatment, have been evaluated. Surgically, the technical method of harvesting the vein has been shown to affect SVG patency. From a pharmacologic perspective, only two guideline class I recommended medications, aspirin and statins, have been shown to improve short- and long-term SVG patency after CABG. Despite these surgical and medical advances, SVG disease remains a significant problem with 1-year patency rates of 89% dropping to 61% after 10 years. This review discusses the pathogenesis of SVG disease, predictors of SVG failure, and current surgical and pharmacologic therapies to address SVG disease, including possible future treatment.