The percutaneous treatment of patients with obstructive atherosclerotic disease in diseased coronary saphenous vein bypass grafts still remains a challenge in interventional cardiology. We discuss the actual evidence-based knowledge for the percutaneous management of this lesion subset, focusing on the devices that are actually considered the gold standard for this treatment: bare-metal stents and distal protection devices. We also comment the negative results of the trials regarding the promising covered stent-grafts. We finally offer insights into the currently available evidence for the use of drug-eluting stents in saphenous vein grafts. These devices are potentially a promise for the successful sealing of vein graft disease, however, available long-term safety and effectiveness data are conflicting and give reason for caution.