Transcatheter embolization of a giant coronary artery pseudoaneurysm

A 53-year-old diabetic male with sternal dehiscence presented with recurrent staphylococcus bacteremia 2 years after coronary artery bypass grafting (CABG). He was found to have a giant right coronary artery (RCA) pseudoaneurysm and a coronary cameral fistula on imaging. Due to excessive surgical risk, the patient underwent percutaneous treatment with a 5 mm Amplatzer vascular plug 4 (St. Jude Medical, St.Paul, MN). Post-procedure imaging showed successful cessation of flow into the pseudoaneurysm and follow-up CT scan demonstrated significant improvement in the size of the pseudoaneurysm.     

Unruptured left ventricular pseudoaneurysm following myocardial infarction

A 73 year old man developed a left ventricular pseudoaneurysm following acute myocardial infarction. Coronary angiography showed triple vessel disease with total occlusion of the right coronary artery. On left ventriculography, a serpentine-like pseudoaneurysm was demonstrated that originated from the posterobasal wall of the left ventricle and extended to the right ventricular free wall. He underwent coronary artery bypass surgery with no plication of the pseudoaneurysm. An organised thrombus was also found within the cavity of the pseudoaneurysm. He was doing well approximately eight months after the operation. The prognosis might be determined by the organised thrombus, the serpentine-like structure of pseudoaneurysm, the coronary revascularisation, and the vigorous medical management.

Keywords: acute myocardial infarction;  pseudoaneurysm;  coronary artery bypass surgery     

Off-pump reconstruction of pseudoaneurysm of the descending thoracic aorta.

We report 2 cases of postoperative pseudoaneurysm of the descending thoracic aorta, repaired successfully by temporary bypass graft without extracorporeal bypass. One patient presented with a large recurrent pseudoaneurysm that developed 30 years after ligation of a patent ductus arteriosus. The other patient presented with a pseudoaneurysm 18 years after thoracic aortic reconstruction for a traumatic aneurysm. In both cases, a temporary bypass graft was created from a major branch of the aortic arch to the femoral artery prior to definitive reconstruction. The postoperative course was uncomplicated by organ dysfunction or neurologic deficit. Creation of a temporary bypass graft can avoid the need for cardiopulmonary bypass in selected patients. By avoiding heparin use, blood loss is decreased, especially when dense pulmonary adhesions from previous surgery are present.     

Successful treatment of a saphenous vein graft pseudoaneurysm with PTFE-covered JoStents

A pseudoaneurysm of a saphenous vein bypass graft to a first diagonal coronary artery is reported. The patient presented with worsening angina symptoms 14 years after her first bypass surgery when this diagonal graft was implanted. Angiography revealed a 3 x 3 cm pseudoaneurysm of the graft. The perforation site was successfully occluded by two overlapping polytetrafluoroethylene (PTFE)-covered JoStents.     

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

A 72‐year‐old man with prior history of coronary artery bypass grafting and sternal wire infection presented with non‐ST‐segment elevation myocardial infarction. His coronary angiogram revealed stenosis of the distal left main coronary artery (LMCA) and a pseudoaneurysm of saphenous venous graft (SVG) to right posterior descending artery. Patient developed ventricular fibrillation during admission, and postcardiopulmonary resuscitation, a pulsatile chest mass was observed which was diagnosed with computed tomography as a chest wall collection resulting from rupture of the pseudo‐aneurysm. He underwent percutaneous coronary intervention of the LMCA with drug‐eluting stents followed by successful coil embolization of the SVG pseudoaneurysm. Patient had an uneventful recovery postprocedure.     

Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described.We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery–saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization.     

Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

Saphenous vein grafts (SVG) pseudoaneurysms, especially giant ones, are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina, dyspnea, myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain, dyspnea and was noted to have significantly engorged neck veins. In the emergency department, a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery (RPDA). This imaging modality also demonstrated compression of the superior vena cava (SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films, a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVC compression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary, saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications, the patency of the affected vein graft and the involved myocardial territory viability.     

Treatment of a ruptured saphenous vein graft pseudoaneurysm using a vascular plug

Saphenous vein graft pseudoaneurysm is an uncommon complication of coronary bypass grafting. Hemoptysis associated with diffuse bleeding into the lung tissue may be the initial manifestation of this condition. We report a case of a saphenous vein graft pseudoaneurysm that presented with hemoptysis and was successfully treated with a proximal vascular plug. © 2008 Wiley‐Liss, Inc.     

Post-Traumatic Pseudoaneurysm of the Left Sinus of Valsalva Revealed by an Acute Coronary Compression

A 69-year-old woman presented with chest pain and electrocardiographic evidence ofsubacute anterior ischaemia. Transthoracic and transesophageal echocardiography allowed correct diagnosis of a post-traumatic pseudoaneurysm of the left sinus of Valsalva. The large pseudoaneurysm caused compression of the left main coronary artery and was successfully treated by aortic root replacement, left main coronary artery ligation, and arterial bypass.     

Giant left main pseudoaneurysm obstructing the left anterior descending coronary artery demonstrated by transesophageal echocardiography and coronary angiography

Left main pseudoaneurysm is a rare angiographic finding in young adults. We describe a 23-year-old male who presented with an acute anterior wall myocardial infarction. Coronary angiography and transesophageal echocardiography reveal a huge aneurysm of the distal left main obstructing the left anterior descending artery (LAD), which was defined by history as a pseudoaneurysm. The pseudoaneurysm was successfully resected and mammary artery was used to repair the distal left main and to bypass the LAD. © 1993 Wiiey-Liss, Inc.     

Post-Traumatic Pseudoaneurysm of the Left Sinus of Valsalva Revealed by an Acute Coronary Compression: An Echocardiographic Case Report

A 69-year-old woman presented with chest pain and electrocardiographic evidence of subacute anterior ischaemia. Transthoracic and transesophageal echocardiography allowed correct diagnosis of a posttraumatic pseudoaneurysm of the left sinus of Valsalva. The large pseudoaneurysm caused compression of the left main coronary artery and was successfully treated by aortic root replacement, left main coronary artery ligation, and arterial bypass.     

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     

Pseudoaneurysm of the non‐coronary sinus of Valsalva: A rare complication of percutaneous coronary intervention

Pseudoaneurysm of the non‐coronary sinus of Valsalva is an exceptionally rare but potentially fatal complication of percutaneous coronary interventions (PCI). Here, we report a case of a 53‐year‐old man with pseudoaneurysm of the non‐coronary sinus of Valsalva following PCI who presented with recurrent chest pain and was treated successfully by closure of the orifice of the pseudoaneurysm and coronary artery bypass grafting.     

Off-pump resection of aorto-saphenous vein graft pseudoaneurysm

Pseudoaneurysms of saphenous vein grafts are rare. We present the case of a 58-year-old man who presented with recurrent angina nine years following quadruple coronary artery bypass graft surgery in 1983. He was found to have an aneurysm arising from the ascending aorta. The patient underwent off-pump aorto-saphenous vein pseudoaneurysm resection and redo coronary artery bypass grafts.     

Endovascular repair of a giant carotid pseudoaneurysm with the use of Viabahn stent graft.

A 72-year-old woman presented with a large pulsatile anterior right neck mass with compressive symptoms of dysphagia and hoarseness. This was due to a large (6 cm by 4 cm) postcarotid endarterectomy pseudoaneurysm of the right common carotid artery. Successful endovascular exclusion of the pseudoaneurysm was performed with a Viabahn stent graft with significant decrease in the size on follow-up. Other endovascular options such as coil embolization and thrombin injection are also discussed. It is important to exclude infection as the cause of postendarterectomy pseudoaneurysm before considering endovascular repair over surgical repair.     

Primary hemangiopericytoma of the heart associated with pseudoaneurysm of the pulmonary artery--a case report

A thirty-three-year-old male with malignant hemangiopericytoma of the right ventricular outflow tract and the pulmonary artery associated with pseudoaneurysm formation at the latter is presented. Contrast computed tomography was helpful in diagnosing the pseudoaneurysm of the pulmonary artery. The positional change of the murmur, with a tumor plop caused by the pedunculated tumor of the right ventricular outflow tract, was detected.     

An unusual complication of left ventricular pseudoaneurysm: hemoptysis

Left ventricular aneurysm is a common sequela of anterior myocardial infarction. At the time of coronary artery bypass grafting, resection of this aneurysm is frequently undertaken to alleviate symptoms of heart failure and/or refractory ventricular tachycardia. Complications related to aneurysmectomy are uncommon. We describe an unusual patient who presented with hemoptysis related to the formation of a pseudoaneurysm which communicated with the lung parenchyma. The etiology of the pseudoaneurysm formation was an indolent, slow-growing infection.     

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.