Leaking false aneurysm of right coronary saphenous vein graft: successful treatment by percutaneous coil embolisation

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Leaking false aneurysm of right coronary saphenous vein graft; successful treatment by percutaneous coil embolisation.

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Leaking false aneurysm of right coronary saphenous vein graft: successful treatment by percutaneous coil embolisation

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.     

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts

Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.

Keywords: aneurysm;  pseudoaneurysm;  saphenous vein grafts;  coronary artery bypass graft     

Apparent obstruction of the superior vena cava and a continuous murmur: signs of a fistula between a vein graft aneurysm and the right atrium

A previously undescribed complication of a saphenous vein aortocoronary bypass graft, namely formation of a fistula between a vein graft aneurysm and the right atrium is reported. A patient presented with a continuous murmur and a combination of signs suggesting superior vena cava obstruction. This pathology was shown by both echocardiography and angiography. Surgical treatment was attempted.     

Apparent obstruction of the superior vena cava and a continuous murmur: signs of a fistula between a vein graft aneurysm and the right atrium.

A previously undescribed complication of a saphenous vein aortocoronary bypass graft, namely formation of a fistula between a vein graft aneurysm and the right atrium is reported. A patient presented with a continuous murmur and a combination of signs suggesting superior vena cava obstruction. This pathology was shown by both echocardiography and angiography. Surgical treatment was attempted.     

Apparent obstruction of the superior vena cava and a continuous murmur: signs of a fistula between a vein graft aneurysm and the right atrium

A previously undescribed complication of a saphenous vein aortocoronary bypass graft, namely formation of a fistula between a vein graft aneurysm and the right atrium is reported. A patient presented with a continuous murmur and a combination of signs suggesting superior vena cava obstruction. This pathology was shown by both echocardiography and angiography. Surgical treatment was attempted.     

Multisaccular aneurysm in a coronary vein graft

This report describes an unusual multisaccular vein graft aneurysm that developed in a patient who had undergone aortocoronary bypass with a saphenous vein graft. The aneurysm was a complication of an atherosclerotic lesion. This case supports the belief that aortocoronary vein grafts have an increased susceptibility to aneurysm formation.     

Electrocardiographic changes during selective aortocoronary saphenous vein bypass graft angiography in man

Simultaneous leads I, II, and III of the electrocardiogram were recorded during selective aortocoronary saphenous vein bypass graft angiography in 20 patients. Arrhythmias associated with such graft opacification included sinus bradycardia, sinus arrest, atrial premature beats, ventricular premature beats, ventricular tachycardia and two episodes of ventricular fibrillation. Rhythm disturbances were unrelated to the anatomic location of the grafts. Patent right graft injection effected a mean rightward frontal plane QRS axis shift of 32.7 ° with leftward T wave axis deviation. A majority of subjects with patent aortic-left anterior descending coronary arterial grafts also manifested right axis shift (mean 22.6 °), possibly related to collateral circulation between the left and right coronary arterial systems. Those patients with stenosed and occluded grafts had minimal or no electrocardiographic changes during bypass angiography. It is concluded that electrocardiographic alteration during graft angiography is a physiologic demonstration of aortocoronary bypass efficacy.     

Electrovectorcardiographic changes after proximal right coronary artery venous bypass graft and distal gas endarterectomy

Serial electrocardiograms and vectorcardiograms were obtained from 10 consecutive patients who underwent combined proximal right aortocoronary saphenous vein bypass graft implantation and distal right coronary gas endarterectomy. Nine of these subjects manifested postoperative electrovectorcardiographic changes of acute inferior wall myocardial infarction. Only 1 of 13 other patients who were subjected to right bypass graft implantation without gas endarterectomy had similar findings. All 9 patients who were subjected to gas endarterectomy and who manifested postoperative patterns of infarction had a clinically uncomplicated postoperative course and were discharged on the 10th to 12th postoperative day.     

Evaluation of serum levels of solubilized adhesion molecules in patients with aortocoronary saphenous vein grafts

OBJECTIVE: To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease. METHODS: The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation. RESULTS: Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9+/-21.7 versus 48.7+/-18.6 ng/ml, P<0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin >57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis. CONCLUSION: In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease.     

Recanalization of chronically occluded aortocoronary saphenous vein bypass grafts by extended infusion of urokinase: initial results and short-term clinical follow-up

Chronic occlusion of saphenous vein aortocoronary bypass grafts is a common problem. Although percutaneous transluminal angioplasty of a saphenous vein with a stenotic lesion is feasible, angioplasty alone of a totally occluded vein graft yields uniformly poor results. Patients with such occlusion are often subjected to repeat aortocoronary bypass surgery. Experience with a new technique that allows angioplasty to be performed in a totally occluded saphenous vein bypass graft is reported. This technique utilizes infusion of prolonged low dose urokinase directly into the proximal portion of the occluded graft. Forty-six consecutive patients with 47 totally occluded grafts were studied. Patients had undergone end to side saphenous vein bypass grafting 1 to 13 (mean 7) years previously. All patients presented with new or worsening angina pectoris with ST-T changes or non-Q wave acute myocardial infarction and all had a totally occluded saphenous vein bypass graft. The new technique entailed the positioning of an angiographic catheter into the stub of the occluded graft and the advancement of an infusion wire into the graft. Patients were returned to the coronary care unit, where urokinase was delivered at a dose of 100,000 to 250,000 U/h. The total dose of urokinase ranged from 0.7 to 9.8 million U over 7.5 to 77 h (mean 31). After therapy, recanalization was seen in 37 (79%) of the 47 grafts. In 20 successfully treated patients, angiography was performed 1 to 24 (mean 11) months after treatment; 13 (65%) of these grafts were patent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries

Aneurysm formation in saphenous vein aortocoronary bypass grafts is an extremely rare complication of coronary artery bypass surgery. Aneurysms of native coronary arteries are found in a small percentage of patients at autopsy. Reported is a case with multiple coronary artery aneurysms in which a dissecting aneurysm of the saphenous vein bypass graft also developed following coronary artery bypass surgery. This is the first report of such association.     

Aortocoronary bypass saphenous vein graft atherosclerosis: Anatomic study of 99 vein grafts from normal and hyperlipoproteinemic patients up to 75 months postoperatively

In this anatomic study of 99 saphenous vein grafts recovered at autopsy from 55 patients who survived aortocoronary bypass for 0 to 75 months, a comparison was made between patients with normal and elevated lipid levels in regard to the severity of vein graft intimai proliferation and the prevalence of true atherosclerosis. Although progression of intimai proliferation with time occurred in both patient groups, a greater proportion of hyperlipemic patients had high grade luminal narrowing of vein grafts as the interval after aortocoronary bypass increased. True atherosclerosis did not develop before 12 months in any of the 59 vein grafts from the 27 normolipemic and 5 hyperlipemic patients who survived aortocoronary bypass, but it occurred in 3 of 26 vein grafts (11.5 percent) from normolipemic and 11 of 14 vein grafts (78.6 percent) from hyperlipemic patients who survived 13 to 75 months after aortocoronary bypass. The observation that microscopic changes of atherosclerosis may occur in saphenous vein grafts in some patients without hyperlipemia also emphasizes the importance of effective control not only of blood lipids but also of the other recognized risk factors for atherosclerosis.     

Transcatheter embolization of a leaking pseudoaneurysm of saphenous vein aortocoronary bypass graft

We present a case of successful transcatheter embolization of a leaking pseudoaneurysm of an autogenous saphenous vein aortocoronary graft that developed 9 years following bypass surgery.     

Systemic and local saphenous vein graft thrombolysis using a tissue plasminogen activator

Many studies are currently evaluating the potential role of thrombolytic therapy in patients with ischemic syndromes who have undergone previous coronary artery bypass grafting. Limited experience has been published regarding the use of local urokinase and streptokinase infusions and the use of systemic recombinant tissue-type plasminogen activator as thrombolytic agents in patients with previous coronary artery bypass surgery. To date, however, there has been no published experience regarding the use of recombinant tissue-type plasminogen activator (rt-PA) either systemically or locally in the post-bypass patient where angiographic demonstration of aortocoronary saphenous vein graft obstruction was available pre- and post-therapy. Similarly there has been no previous report of the use of rt-PA infused locally to recanalize an occluded aortocoronary saphenous vein graft. This report describes successful thrombolysis and subsequent balloon angioplasty of saphenous vein grafts with angiographically documented thrombus using systemic and local rt-PA infusion.     

A case with spasm of a saphenous vein graft

A 54-year-old man developed angina pectoris 18 months after a successful aortocoronary bypass graft. The angiogram demonstrated patent grafts and no significant changes in the native coronary vessels. However, ergonovine maleate provoked spasm in a saphenous vein graft.     

Retrograde dilatation of a totally occluded ostial left anterior descending artery from saphenous venous graft in the descending aorta following stenting of the aorto-ostial graft restenosis in a patient with left main coronary artery stenosis.

Treatment of native coronary and saphenous vein graft aorto-ostial stenoses with balloon angioplasty is associated with lower procedural success rates and more complications compared with percutaneous transluminal coronary angioplasty of nonostial stenoses. A patient with totally occluded ostial left anterior descending artery at ostium following aortocoronary bypass developed ostial stenosis at the saphenous vein graft in the descending aorta. The aorto-ostial lesion of saphenous vein graft was successfully stented and was followed by retrograde dilatation of the left anterior descending artery, and the totally occluded ostial lesion was reopened. The ischemia was eliminated following the procedure.     

Prinzmetal's variant form of angina with arteriographic evidence of coronary arterial spasm

Spasm of the proximal right coronary artery was arteriographically demonstrated during an episode of chest pain in a patient with Prinzmetal's variant form of angina. A right aortocoronary saphenous vein bypass procedure was performed but, despite a patent graft, the angina recurred and the patient died. The only significant finding at autopsy was an eccentric atherosclerotic plaque that narrowed the right coronary artery by 75 percent at the site of the spasm. These findings support Prinzmetal's hypothesis that this variant form of angina is produced by spasm of a coronary artery with a seriously compromised lumen.