Introduction
Coronary artery bypass grafting remains one of the best therapies for
advanced coronary artery disease. The most used conduit remains the great
saphenous vein, which is susceptible to short-term and long-term failure,
the result of acute thrombosis, intimal hyperplasia, and late superimposed
atheroma. In this review, we present the current findings related to the
pathophysiology of vein graft failure.
Methods
A search of three databases - MEDLINE®, Web of Science™, and
Cochrane Library - was undertaken for the terms “pathophysiology”,
“prevention”, and “treatment” plus the term “vein graft failure”.
Results
The pathophysiology of saphenous graft failure can be classified in three
distinct phases - acute thrombosis, intimal hyperplasia, and accelerated
atherosclerosis. All these processes start with an underlying histological
predisposition of the vein and at the time of harvesting and preparation for
grafting. These mechanisms are a result of localized inflammatory and
prothrombotic cascades that obey different causes, but ultimately result in
the stenosis or occlusion of the vein graft.
Conclusion
The interaction between the different parts of the pathophysiology of vein
graft failure is extremely complex and variable. Recent improvements in
surgical techniques and secondary pharmaceutical prevention like early
aspirin administration and long-term statin treatment have significantly
reduced early and late saphenous vein graft failure. However, this continues
to be a fascinating area of research with the potential for further
improvement for patients and health service provision.