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The future of saphenous vein graft for coronary artery.

developed in the late 1960s by Favaloro and using saphenous vein grafts dramatically changes the treatment and the prognosis of patients with ischemic coronary artery disease. The aim of the surgical procedure is to improve patients’ quality of life alleviating anginal symptoms and restore physical activity, as well as increasing survival in certain groups of patients, especially in those at higher risk. However, inherent factors to both procedure and basal disease affect and even suppress the long-term benefits provided by coronary artery bypass graft surgery. Among these factors, the venous graft degeneration is yet one of the greatest drawbacks. The coronary artery bypass graft surgery success is, to a great extent, related to the type and quality of the graft employed. However, this continues to be our dilemma, once the only graft which has been shown excellent long-term outcomes and considered to be the gold standard in coronary artery bypass graft surgery is the pediculated left internal thoracic artery, when it is anastomosed to the anterior descending artery. Nevertheless, the complete myocardial revascularization is the goal to be achieved, treating all severely stenosed coronary arteries causing ischemia, assuring the remission of symptoms and increasing survival. Thus, the use of saphenous vein grafts is still vital to accomplish this goal. Moreover, up to the present time, there is no demonstration of the superiority of arterial grafts (except the internal thoracic artery grafts) over the saphenous vein grafts. Techniques and strategies to better preserve structurally and functionally the saphenous vein could safely contribute to a better outcome, once the increased patency grafts correlates to an increased survival in the long-term. The superior outcomes achieved by means of the internal thoracic artery are due partly to the scrupulous caution devoted by the surgeon to the dissection and the minimal surgical trauma of this conduit, thus avoiding traumas that could jeopardize its patency. However, this same caution is not addressed to the saphenous vein graft, Editorial