Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) currently accounts for approximately 6 % of all PCIs and is associated with increased risk for distal embolization and subsequent SVG failure compared with native coronary artery PCI. To minimize the risk for distal embolization, embolic protection devices should be used during SVG PCI when technically feasible. To minimize the risk for in-stent restenosis and the need for repeat PCI, drug eluting stents should be utilized in patients without contraindications to long-term antiplatelet therapy. Treating native coronary artery lesions is preferable to SVG PCI when technically feasible.