Coronary artery bypass grafting (CABG) is one of the most common cardiac surgical procedures performed worldwide [
1]. Despite arterial conduits having a superior long-term graft patency rate, the long saphenous vein is still the first choice conduit as a second graft in multi-vessel bypass grafts [
2,
3]. Endoscopic vein harvesting (EVH) has become one of the most favourable techniques for conduit retrieval due to the reduction in wound complications, ameliorated postoperative pain and improved cosmetic outcome compared to traditional harvesting methods. However, no consensus has been reached regarding long term graft patency, with both positive [
1,
4,
5] and negative [
6,
7] data reported in clinical [
8,
9] and histological studies [
10]. A major impediment to long term bypass success is vein graft failure or occlusion, which can occur early or late. Numerous factors contribute to vein graft failure, including conduit quality [
11,
12], graft diameter [
13], type of graft [
14,
15], grafting site [
16], handling of the conduit [
17], surgical conduit preparation [
18], grafting technique [
16,
17], patient risk factors [
19] and technical error [
17,
20]. Recent evidence also suggests that the harvesting method used [
8,
21] and operator ability/experience [
6] are of vital importance. This literature review seeks to address the effect of the EVH learning curve period on patient safety and highlights potential methods to minimise the impact of practitioner inexperience.