Great Saphenous Vein: The Preferred Graft for Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting (CABG) is a surgical procedure designed to improve blood flow to the heart by using a graft to bypass blocked coronary arteries. Historically, the saphenous vein has been a reliable and commonly used graft for this procedure. Among the veins, the great saphenous vein (SV) stands out as the preferred choice due to its physiological properties and surgical advantages.

Saphenous Vein (SV)

The saphenous vein is a superficial vein in the leg and thigh that drains blood from the lower extremities. The great saphenous vein, originating from the medial side of the foot, is the longest vein in the body, extending upwards to the groin and connecting to the femoral vein.

Common Use in CABG

In recent decades, the use of the great saphenous vein for CABG has become increasingly prevalent. Surgeons prefer it due to several key attributes:

Long and Straight Profile: The great saphenous vein’s long and straight nature facilitates easier harvesting andimplantation. It is less likely to kink or occlude during the procedure. Blood Supply: The vein has a consistent and robust blood supply, ensuring it remains viable during and after the surgery. This reduces the risk of graft occlusion over time. Lower Infection Risk: The great saphenous vein has a lower incidence of post-operative infections when compared to other veins used in bypass procedures.

Alternative Grafts

While the great saphenous vein is the most widely used, other vein grafts can also be considered in CABG procedures. These include:

Radial Artery: The radial artery, derived from the arm, is known for its high patency rates and is particularly useful for left main coronary artery bypasses. However, its use can be limited due to the need to harvest the artery from the arm. Internal Mammary Artery (IMA): This is a preferred graft due to its consistent low patency rate and long-term durability. However, it is typically used for left internal thoracic artery (LITA) grafts, which are harder to harvest and maintain. Short and Superficial Inferior Epigastric Artery (SIEA): These are smaller arteries that can be used as an alternative, but they are less commonly employed due to their smaller diameter and potential for lower patency rates.

Evolution of Graft Choice Over Time

Around forty years ago, the preference was exclusively for superficial leg veins for CABG. However, the field has evolved, and alternative sources, particularly from the upper chest or arms, are now commonly used. These alternatives, such as the radial artery and internal mammary artery, offer distinct advantages in certain clinical scenarios. For instance, the use of the radial artery can be particularly beneficial in younger patients where long-term patency may be of paramount importance.

Today, the choice of graft depends on a variety of factors, including the patient’s specific needs, the surgeon’s skills, and the availability of different grafts. The great saphenous vein remains a reliable and widely used choice, especially in cases where a longer vessel is needed, such as for the left anterior descending (LAD) artery or other major coronary arteries.

In conclusion, the great saphenous vein continues to play a significant role in coronary artery bypass grafting, offering a reliable and consistent graft option for surgeons. As medical technology and surgical techniques continue to evolve, the use of the great saphenous vein, along with other graft options, will likely continue to adapt to meet the needs of both patients and clinicians.