Despite continued improvements in the selection of patients, preoperat
ive and intraoperative diagnostic imaging, and surgical techniques, gr
aft failure remains a substantial problem for both autogenous and pros
thetic bypass grafts. The use of anticoagulants and other pharmacologi
c agents to prolong graft patency is discussed, and practical suggesti
ons are made regarding the best current management for high-risk bypas
s grafts.