Saphenous vein graft (SVG) occlusion following surgery continues to be a significant limitation of CABG. OCT has the potential to identify the features of atherosclerosis, including circumferential fibrous neointima, TCFA and adherent thrombus. It can provide significant insights into the causes of vein graft failure. OCT of culprit lesions of old SVGs in patients with ACS can show fibrofatty composition, relatively thin fibrous cap, plaque rupture, and thrombus. The VEST study revealed that OCT is useful for characterizing luminal features of SVGs that are not clearly seen using IVUS. OCT could also identify differences in SVGs with and without external stent support.

A recent Indian case report suggested the safety and feasibility of LMWD-40-based OCT-guided zero contrast PCI in in-stent restenosis of SVG in a CKD patient. Another recent study compared the morphology of SVG in stenotic vs. nonstenotic lesions using OCT imaging in 29 patients hospitalized within the OCTOPUS registry. Stenotic lesions were characterized by higher incidence of thin-cap fibroatheroma (TCFA), thrombus, lipid-rich plaque (LRP) and plaque within the SVG valve as compared to nonstenotic lesions.

OCT provides good reproducibility for the measurements of parameters relevant for the development of atherosclerosis in vein grafts.