Gene therapy for vein graft disease

The durability of coronary artery bypass grafting is intrinsically dependent upon the patency of the graft. The long term patency of arterial grafts, in particular internal mammary grafts, has been clearly defined by multiple groups to be greater than 90% at 10-20 years following construction. This has been fully addressed in Chaps. 13 and 14. Moreover, a recent randomized trial between radial artery and saphenous vein grafts demonstrated the superiority of radial artery conduits at 1 year [1].However, certain clinical scenarios require the use of venous grafts. The intrinsic limitations of saphenous vein bypass grafts and the subsequent acceptance of these imperfections guide our clinical decisions in a fundamental fashion. To address these shortcomings in saphenous vein grafts, a growing body of research has endeavored to improve the function of saphenous veins in an attempt to ultimately increase patency rates and durability of the surgical revascularization.