Saphenous vein graft failure: seeing the bigger picture

Approximately 50% of saphenous vein grafts (SVGs) fail by 5 to 10 years post-coronary artery bypass grafting (CABG) and between 20–40% fail within the first year (1,2). While SVG failure can sometimes be silent, when symptomatic events occur, SVG percutaneous coronary intervention (PCI) is often performed. SVG PCI represents approximately 6% of the total PCI volume in the US (3). Given the aggressiveness of SVG atherosclerosis and the high risk for recurrent SVG failure, what are the optimal prevention and treatment options in such patients?