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Heng et al. Vessel Plus 2023;7:31 Vessel Plus
DOI: 10.20517/2574-1209.2023.97

Review Open Access

The biomechanics and prevention of vein graft

failure in coronary revascularization

2,3
1,2
1,2
1,2
Elbert E. Heng , Hanjay Wang , Oluwatomisin Obafemi , Alison Marsden , Y. Joseph Woo 1,2,3 , Jack H.
Boyd 1,2
1
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
2
Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA.
3
Department of Bioengineering, Stanford University, Stanford, CA 94035, USA.
Correspondence to: Dr. Jack H. Boyd, Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension,
Palo Alto, CA 94305, USA. E-mail: jackboyd@stanford.edu
How to cite this article: Heng EE, Wang H, Obafemi O, Marsden A, Woo YJ, Boyd JH. The biomechanics and prevention of vein
graft failure in coronary revascularization. Vessel Plus 2023;7:31. https://dx.doi.org/10.20517/2574-1209.2023.97
Received: 1 Aug 2023 First Decision: 19 Sep 2023 Revised: 31 Oct 2023 Accepted: 8 Dec 2023 Published: 15 Dec 2023
Academic Editors: Jerzy Beltowski, Antonio Calafiore Copy Editor: Fangyuan Liu Production Editor: Fangyuan Liu

Abstract
Saphenous vein grafts (SVGs) are the most widely used conduit in coronary artery bypass grafting (CABG)
surgery; however, SVG failures due to neointimal hyperplasia present a significant long-term limitation to the
effectiveness of myocardial revascularization. This review will provide a comprehensive overview of the biological
mechanisms of vein graft failure, including compensatory endothelial proliferation, extracellular matrix deposition,
and adventitial disruption. We will discuss historical and emerging strategies for vein graft failure prevention with a
focus on the role of mechanical vein graft support using external stenting. Finally, we will highlight the results of
preclinical and human trials and discuss future directions for investigation.

Keywords: Coronary artery bypass grafting, saphenous vein, vein graft failure, neointimal hyperplasia, external
stenting, vein graft remodeling

INTRODUCTION
Coronary artery bypass grafting (CABG) is the gold-standard treatment for increasing survival in patients
with multivessel coronary artery disease (CAD), and saphenous vein grafts (SVGs) remain the most widely
used conduit in over 350,000 surgeries performed annually in the United States . Despite advances in
[1]
surgical care and technique, SVG failure following CABG remains a significant cause of morbidity in the

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