Saphenous Vein Grafts

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Coronary artery disease (CAD) is a highly prevalent and initial consensus disease afflicting many. Recently, the 2016 Heart Disease and Stroke Statistics update of the American Heart Association (AHA) reported a disease prevalence of 15.5 million persons among those 20 years and older in the USA. The treatment of CAD ranges from medical management and lifestyle modification to invasive coronary revascularization. Coronary revascularization was first performed in 1960 by Dr. Robert H. Goetz who performed a right internal mammary artery (RIMA) anastomosis to the right coronary artery, and in 1967 Dr. René Favaloro first described the use of an autologous reversed greater saphenous vein (GSV) graft as a bypass graft. An easily accessible and reliable conduit with a significant length, the GSV continued to be the conduit of choice until 1986 when data revealed the left internal mammary artery (LIMA) as a superior vessel to revascularize the left anterior descending artery (LAD) territory of the myocardium. The LIMA graft showed a significant increase in graft patency and patient survival as compared to GSV and thus became the initial consensus vessel of choice for CABG. While the LIMA is currently used to revascularize LAD territory and in certain circumstances can be anastomosed to multiple vessels in sequential bypassing, it is not always a viable graft, and there is frequently a need for additional vessel harvest to revascularize other diseased segments. As coronary artery bypass grafting continues to evolve, saphenous vein grafts have remained as important conduits during revascularization of multi-vessel coronary artery disease or single vessel disease in which the LIMA has been rendered unusable.

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ePub ahead of print