Early vein graft failure

Coronary artery bypass grafting is a revascularization strategy that improves the clinical outcome of patients with coronary artery disease, but its clinical effectiveness may be hampered by graft occlusion. The mechanisms of graft failure are complex and multifactorial. Graft failure is defined as acute (<1 month), early (1–12 months), and late (>12 months) post surgery and the mechanisms are usually discreet. Graft manipulation and vein biology post engraftment may affect the risk of early acute graft failure. Activation of smooth muscle cell and adventitial fibroblasts, triggered also by the adaptation of the vein to arterial conditions, are involved in extracellular matrix remodelling and intimal hyperplasia development. Graft atherosclerosis can also result in late graft failure. This chapter summarizes the mechanisms of graft failure, provides an overview of the magnitude of the problem of early graft failure, and discusses potential therapeutic strategies.