The purpose of this study is to evaluate the potential efficacy of saphenous vein graft (SVG) angioplasty. Angioplasty of 64 lesions in SVG was performed in 32 patients. (balloon angioplasty for 59 lesions and directional atherectomy for 5 lesions). The angioplasty site involved the proximal vein graft including aortic anastomosis in 9 lesions, the midportion of the graft in 32 lesions, and the distal anastomotic site in 17 lesions. Six grafts were totally occluded. The overall initial success rate was 89%, and restenosis rate was 57%. The initial success rate was lower in occluded grafts (75%) than in proximal (89%), midportion (94%), or distal lesions (88%). There were similar trend for restenosis (proximal 67%, midportion 50%, distal 56%, occluded 75%). The initial success rate was higher in vein graft < 1 year old compared with graft 1 to 5 years or > 5 years after operation (100% versus 87%, 82% respectively). The restenosis rate did not depend on graft age (< 1 year 53%, 1 to 5 years 75%, > 5 years 50%). There was no procedural death or emergent operation. Distal embolization occurred in two cases, both of which underwent directional atherectomy. Angioplasty of a non occlusive obstruction in saphenous vein graft had an initial success rate of approximately 90% and is a safe procedure. Angioplasty of chronic total occlusion was associated with poor acute result. Although the induced high restenosis rate remains a significant problem, angioplasty of saphenous vein graft is a reasonable alternative to revasculization.