In spite of their limited long-term patency, saphenous vein grafts continue to be widely used in patients undergoing coronary artery bypass surgery. Careful surgical technique reduces to some extent the vascular endothelial damage occurring during surgery. Antiplatelet and antithrombotic therapy decrease vein graft occlusion in the short term but probably not in the long term. Lipid lowering therapy improves late vein graft patency, but its long-term benefit must be more firmly established. The value of external stenting for reducing intimal thickening of vein grafts remains controversial. The role of the internal thoracic artery as a bypass conduit is well established, but the mid- and long-term usefulness of other arterial conduits requires further study. Artificial grafts and allografts are still in the early stage of development. The indications, technical limitations, and long-term results of reoperation and balloon angioplasty have recently become better defined. However, more data are needed on the safety and efficacy of new technological devices such as intravascular stents, atherectomy, and laser angioplasty. Finally, randomized trials comparing different revascularization strategies in the management of high-risk patients with old, degenerated saphenous vein grafts are needed for the future.