Abstract
Since Carrell and Guthrie used the reversed saphenous vein graft for arterial reconstruction
in 1906 [1], this technique has undergone several technical modifications to earn
its popularity and credibility [2–4]. Vein preparation has also been refined to attain
optimal preservation of histocytologic integrity in order to improve graft patency
[6–12]. Notwithstanding the periodical enthusiasm to substitute saphenous vein with
biologic [13–15] or prosthetic grafts [16–18], or prosthetic graft with a venous cuff
[19–21] for expedience, autogenous vein graft remains the preferred conduit and the
gold standard in vascular bypass operations. Autogenous vein graft has been subjected
to intense scrutiny for optimal morphologic preservation and identification of etiologic
factors contributing to segmental fibrosclerosis and aneurysmic degeneration. The
anatomic orientation of reversed versus nonreversed vein graft has also been extensively
evaluated for their role in long-term graft function and patency [22]. Despite the
initial nongermane attitude toward vein preparation, there is evidence to support
the importance of the pH, osmolality, osmolarity, and the duration of storage in media,
in the preservation of the integrity of cellular and extracellular elements of the
vein grafts [5,9,10,23–25]. It is well established that durability and long-term patency
of a vein graft is frequently the by-product of at least four vital elements: vein
quality, vein preparation, anatomic orientation and surgical technique.
