Drug eluting stents (DES) have improved percutaneous coronary intervention (PCI) outcomes for most coronary lesion subsets and have gained widespread acceptance. This practice is supported by large-scale clinical trials. Evidence for DES use for treatment of saphenous vein graft (SVG) lesions is less well defined and often conflicting. Most SVG interventions are performed in the setting of an acute coronary syndrome (ACS), in large caliber vascular conduits with soft and friable plaque with inflammatory debris, without a fibrous cap. In this review, we provide an up to date assessment of the published evidence on DES use in PCI of SVG lesions.