Safety and Effectiveness of Saphenous Vein Graft Use for Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention

Contemporary data of saphenous vein graft (SVGs) use in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are limited. We examined the frequency, characteristics, and outcomes of SVG use during retrograde CTO PCI. Retrograde CTO PCI cases in the PROGRESS-CTO registry (2017 to 2025) were compared based on SVG versus non-SVG use; non-native targets, arterial grafts, mixed collaterals, and multi-CTO procedures were excluded. Among 4,330 retrograde procedures (4,321 patients), SVGs were used in 545 (12.6%). These patients were older with more comorbidities, higher anatomic complexity and PROGRESS-CTO score, but similar J-CTO score. Procedure time was longer, yet contrast and radiation exposure were lower. A primary retrograde strategy was used more frequently (54.5% vs 36.0%; p <0.001) in the SVG-group. Technical success was higher with SVGs (82.1% vs 78.5%; p = 0.049), while procedural success (79.9% vs 76.7%; p = 0.092) and in-hospital major adverse cardiac events (MACE) (3.3% vs 2.9%; p = 0.6) were similar. SVG collateral use was independently associated with higher technical success (Odds Ratio 1.60, 95% CI 1.24 to 2.09; p <0.001). Pericardiocentesis was less frequent (0.2% vs 1.6%; p = 0.008) and perforation rates were comparable, but mortality and stroke were higher in the SVG group. Among prior-CABG patients, SVG use was associated with higher technical success but also higher in-hospital MACE (3.3% vs 1.3%; p = 0.011). SVG use for retrograde crossing occurred in approximately 1 in 8 overall and 1 in 3 prior-CABG retrograde CTO PCIs. Despite greater clinical and anatomic complexity, SVG use was associated with higher technical success compared with septal/epicardial collaterals.