Background Saphenous vein grafts (SVGs) remain widely used in coronary artery bypass grafting (CABG). This study examines the role of wall shear stress (WSS) and graft geometry on SVG patency and evaluates the potential of computational fluid dynamics (CFD) as an assessment tool post‐CABG. Methods A systematic search was conducted in PubMed, Cochrane Library, Scopus and EMBASE using the terms ‘wall shear stress’, ‘geometry’, ‘computational fluid dynamics’ and ‘saphenous vein graft patency’. From 374 articles, 82 met the inclusion criteria, focussing on WSS and/or graft geometry in relation to SVG patency in coronary disease. Studies limited to qualitative findings or animal models were excluded, narrowing the selection to 64 eligible articles. Results Adverse WSS conditions were linked to pronounced intimal hyperplasia, atherosclerosis and graft failure. Geometrical factors influencing SVG patency included graft diameter, target coronary diameter (> 2.0 mm), graft wall thickness (> 1.5 mm), curvature at the graft‐host junction and anastomotic angles exceeding 15–20°. CFD‐based evaluations of SVG patency aligned with existing literature findings. Discussion The interplay between SVG patency, WSS and graft geometry is well documented. CFD offers a promising modality for in‐depth graft analysis by gauging geometry and flow dynamics. By delivering objective information, CFD can equip surgeons with the tools to optimise strategies and thereby enhance CABG patient outcomes.
Kader et al. (2025) studied this question.