The Place of Sphenous Vein Garft in Contemporary Coronary Artery Bypass Surgery: The Dilemma of a Time Tested Conduit

Total arterial revascularisation has dominated discussions on contemporary coronary artery Bypass grafting(CABG). Saphenous vein graft(SVG) is the most commonly used conduit of CABG. The strength and weaknesses of SVG are common knowledge. The major weakness of SVG is Failure. This is defined as inability of the graft to deliver adequate oxygen and nutrients to targeted myocardium due to occlusion, aneurysm/rupture or any combination. SVG failure is a significant source of morbidity and mortality, its`divided into early and late with incidence of 10% and 50% at 10years respectively. Factors contributing to SVG failure may be inherent in the vein quality or its handling technique. The use of aneurysmal/varicose vein or traumatic injury to the endothelium could contribute to failure. Often the least experienced surgeon harvests the vein unlike arterial grafts usually dealt with by experienced surgeons. SVG nears achieving the status of ‘ideal conduit for CABG’: It is easy to harvest, available in large quantities, can be used at any coronary target sites for any significant lesion, strategy to ameliorate its weaknesses are known. Its status is validated by strong evidence. No arterial conduit has all these qualities. As coronary artery surgery evolves the utility value of SVG cannot be over emphasised. It is the only conduit with capacity for a ‘bail out’ in catastrophic challenges, due to its versatility. SVG remains an important and indispensable tool for CABG, Investing in strategies to ameliorate the weaknesses of SVG will be of utmost value to CABG and a worthy undertaking.