Vein graft failure: from pathophysiology to clinical outcomes

Nat Rev Cardiol. 2016 Aug;13(8):451-70. doi: 10.1038/nrcardio.2016.76. Epub 2016 May 19.


Occlusive arterial disease is a leading cause of morbidity and mortality worldwide. Aside from balloon angioplasty, bypass graft surgery is the most commonly performed revascularization technique for occlusive arterial disease. Coronary artery bypass graft surgery is performed in patients with left main coronary artery disease and three-vessel coronary disease, whereas peripheral artery bypass graft surgery is used to treat patients with late-stage peripheral artery occlusive disease. The great saphenous veins are commonly used conduits for surgical revascularization; however, they are associated with a high failure rate. Therefore, preservation of vein graft patency is essential for long-term surgical success. With the exception of 'no-touch' techniques and lipid-lowering and antiplatelet (aspirin) therapy, no intervention has hitherto unequivocally proven to be clinically effective in preventing vein graft failure. In this Review, we describe both preclinical and clinical studies evaluating the pathophysiology underlying vein graft failure, and the latest therapeutic options to improve patency for both coronary and peripheral grafts.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon
  • Animals
  • Biopsy
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / surgery*
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / etiology*
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy
  • Humans
  • Peripheral Arterial Disease / diagnostic imaging
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / surgery*
  • Reoperation
  • Risk Factors
  • Saphenous Vein / physiopathology
  • Saphenous Vein / transplantation*
  • Treatment Failure
  • Vascular Patency