Advances in vein graft intervention

While saphenous vein grafts continue to serve as the most common conduit in coronary artery bypass surgery, within the first decade approximately 50% will have developed significant disease. Percutaneous coronary intervention is often undertaken in patients with saphenous vein graft disease as an alternative to reoperation, but is associated with an increased risk of distal embolization, no-reflow, periprocedural myocardial infarction, and late restenosis. Evidence-based clinical trials have established the routine use of stents and distal protection devices as the standard of care for vein graft intervention. Nevertheless, questions persist as to the safety and efficacy of drug-eluting stents in vein grafts given that randomized trial data is minimal and contradictory. This review will examine the evolutionary advances and current status of interventional techniques in treating this problematic disease.