Research progress on the mechanisms and prevention of saphenous vein graft failure after coronary artery bypass grafting
- VernacularTitle:冠状动脉旁路移植术后大隐静脉衰败机制和预防的研究进展
- Author:
Liaoming HE
1
;
Tiemuerniyazi XIERAILI
1
;
Yangwu SONG
1
;
Wei FENG
1
Author Information
1. Adult Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China
- Publication Type:Journal Article
- Keywords:
Coronary artery bypass grafting;
saphenous vein graft;
graft failure;
anastomosis;
pharmacological prevention;
no-touch technique;
graft patency;
review
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(03):475-483
- CountryChina
- Language:Chinese
-
Abstract:
The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG), yet its limited long-term patency adversely affects patient outcomes. SVG failure is a multistage pathological process, characterized by early thrombosis, intermediate intimal hyperplasia, and late atherosclerotic degeneration. These changes are driven by endothelial dysfunction induced by ischemia-reperfusion and mechanical injury, smooth muscle cell phenotypic modulation, inflammatory activation, and conventional cardiovascular risk factors. Preventive strategies for SVG failure have increasingly focused on both surgical and pharmacological optimization. Surgical approaches include appropriate target vessel and anastomotic site selection, refinement of SVG harvesting techniques (notably the no-touch technique and endoscopic vein harvesting), optimization of graft configurations, and routine intraoperative graft flow assessment. Postoperative secondary prevention is essential, as antithrombotic and lipid-lowering therapies have been shown to reduce SVG occlusion. In addition, emerging therapies, including gene-based interventions, antiproliferative agents, novel graft preservation solutions, and external vein graft supports, show promise in improving SVG durability. Integrated multimodal strategies may further reduce SVG failure and improve long-term outcomes after CABG. This article provides a review of researches related to SVG failure, including the mechanisms of failure, intraoperative preventive measures, pharmacological prevention, and recent advances in treatment, aiming to offer insights for clinical diagnosis, treatment and future studies.
