ABSTRACT
A significant decline in primary patency of autogenous grafts invariably occurs over time because of the development of fibrointimal hyperplasia of the vein conduit or anastomotic sites and the progression of atherosclerotic disease of the native arteries. The incidence of lesions that threaten the long-term patency of both in situ and reversed saphenous vein bypasses ranges from 20 to 26% (1-3). Anatomical and hemodynamic alternations that require revision will develop in approximately 5% of vein bypasses per year; the majority of these will occur with the first 2 years after bypass (4). The failure to detect and correct lesions that threaten bypass patency before graft thrombosis significantly decreases long-term patency of the autogenous graft. The long-term patency for revisions of autogenous grafts after thrombosis is dismal. The 3-year patency rate of revision of thrombosed in situ and reversed saphenous vein grafts ranges from 22 to 47% in recent reports (1, 5, 6).
