Background Although saphenous vein grafts (SVG) have been used from 1975 to treat coronary stenosis caused by Kawasaki disease, long-term results after more than 20 years remain unknown. Methods and Results From 1981 to 1997, 13 patients underwent coronary artery bypass grafting using SVG (n=20). The age at operation ranged from 2 to 20 years (median 11 years), the age at latest angiography from 15 to 36 years (median 30 years) and the postoperative follow-up period was from 10 to 26 years (median 22 years). The patency rate of the SVG was determined by postoperative angiography, graft wall morphology was graded and the late clinical course was reviewed. The patency rates at 1, 10, and 25 years after operation were 84.4%, 57.2%, and 51.5%, respectively. Irregularity of the SVG wall was slight in 3 of 7 patients with long-term patency. One patient with obesity and hyperlipidemia underwent stent implantation in the SVG because of graft stenosis. Conclusion Although the patency rates for SVG are low, there are patients with long-term patency over 20 years. Obesity and hyperlipidemia in these patients should be vigorously pursued. (Circ J 2009; 73: 73 - 77)