Aortocoronary saphenous vein graft (SVG) is used in a significant number of coronary artery bypass graft (CABG) operations and is a good choice of myocardial revascularization procedure but ironically SVG failure is its limitation. These thin-walled grafts begin to fail with intimal hyperplasia, thrombosis and progressive atherosclerosis when exposed to an abrupt increase in wall stress imparted by systemic arterial pressure. Frequent association of soft and friable, degenerated vein graft lesions, superimposed thrombus on critical graft stenoses, provide unique challenges due to the propensity for distal embolization resulting in slow or no-reflow phenomena with periprocedural myocardial infarction (MI). Stents to embolic protection devices (EPDs) have evolved very fast with good features and have been used with varied success. This review focuses on the historical evolution of the present day SVG intervention. Nature of vein graft disease and its pathophysiology is discussed.