Review ArticlesSaphenous Vein Graft Disease Review of Pathophysiology, Prevention, and TreatmentKim, Francis Y. MD; Marhefka, Gregary MD; Ruggiero, Nicholas J. MD; Adams, Suzanne RN, MPH; Whellan, David J. MD, MHSAuthor Information From the Jefferson Coordinating Center for Clinical Research, Thomas Jefferson University, Philadelphia, PA. Accepted for publication September 04, 2012 Disclosure: Dr. D.J.W. receives research grants from Medtronic, Inc., Mounds View MN, consultant for Medtronic (<10k), Abbott Labs, Schering Plough/Merck, Novartis; Board membership: Medtronic, Frederick LLC, Clinlogix, Dr. N.J.R. is consultant for St. Jude Medical. The remaining authors report no disclosures. David J. Whellan, MD, MHS, FACC, FAHA, Jefferson Coordinating Center for Clinical Research, Thomas Jefferson University, 1015 Chestnut Street, Suite 317, Philadelphia, PA 19107. E-mail: [email protected] Cardiology in Review: March/April 2013 - Volume 21 - Issue 2 - p 101-109 doi: 10.1097/CRD.0b013e3182736190 Buy Metrics Abstract 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. © 2013 Lippincott Williams & Wilkins, Inc.