Giant saphenous vein graft pseudoaneurysm rupture presenting with cardiac tamponade

Saphenous vein graft aneurysms are a rare but potentially fatal complication following coronary artery bypass graft (CABG) surgery, with a wide variation in clinical presentations ranging from recurrent atypical chest pain to sudden cardiac death. Although uncommon, the diagnosis should be considered in all patients presenting with a hilar or mediastinal mass following CABG, as timely treatment may avert potentially fatal aneurysm rupture and death. We report a rare case of a giant vein graft pseudoaneurysm rupture causing cardiac tamponade.     

Asymptomatic saphenous vein graft aneurysm: a case report

The authors report the case of a 48-year-old man with a history of coronary bypass graft 15 years earlier. The follow-up by routine chest radiography showed a right paracardiac opacity, which MRI conformed to be an aneurysm of the saphenous vein graft.     

A large saphenous vein graft aneurysm presenting as a right atrial mass: a case report

An aneurysm of a saphenous vein graft (SVG) is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We describe a case of a large SVG aneurysm (7 x 6 cm) compressing the right atrium. The patient presented with chest pain, dyspnea and desaturation, and a right intra-atrial mass was revealed on echocardiography. The differential diagnosis of intracardiac masses revealed by echocardiography should include extrinsic lesions. Due to its potential lethal complications, an SVG aneurysm should be considered in a post-CABG patient presenting with acute coronary syndrome or heart failure.     

Percutaneous treatment of a massive saphenous vein graft aneurysm

Saphenous vein graft (SVG) aneurysms are a rare, frequently late presenting, potentially fatal complication of coronary artery bypass graft (CABG) surgery. They are often discovered incidentally during radiological tasks such as chest x‐ray or CT but can present clinically with symptoms such as worsening angina and breathlessness as well as complications such as rupture or myocardial infarction. Given the risks if left untreated, consideration should be given to treatment either through percutaneous routes or open surgery. However, because of a lack of strong evidence, there are no definitive guidelines on the treatment of SVG aneurysms. We describe a patient with an extensive cardiac surgical history who presented with angina and breathlessness and was found to have a large SVG aneurysm, subsequently successfully treated with percutaneous coronary intervention with covered stents.     

Successful closure of a giant true saphenous vein graft aneurysm using the Amplatzer vascular plug.

An 85-year-old man was found to have a 9 cm diameter true aneurysm of an obtuse marginal saphenous vein graft. The graft was fed by a relatively narrow neck from the proximal remnant of the obtuse marginal graft 10 years after prior coronary artery bypass graft surgery. An Amplatzer vascular plug was used successfully to occlude the neck of the aneurysm. Follow-up CT scan 1 month afterward demonstrated retained contrast in the aneurysm, demonstrating complete occlusion between the aorta and aneurysm sac. Pressure recordings from within the aneurysm sac suggest bidirectional flow in the neck as the mechanism for the maintained patency of the aneurysm. The use of a vascular plug is an effective method for aneurysm occlusion when the anatomy is suitable.     

Occlusion of a saphenous vein graft aneurysm with a vein-covered stent

A 67-year-old man was admitted with unstable angina, 15 years after saphenous vein graft bypass surgery. Cardiac catheterization demonstrated a large saccular aneurysm arising from the proximal segment of the vein graft to the obtuse marginal artery. Intravascular ultrasound revealed the opening of the aneurysm that measured 15 mm in length. The aneurysm was successfully occluded by deployment of a vein-covered stent.     

A saphenous vein graft aneurysm with fistula development to the right atrium: Surgical management of a rare bypass graft complication

A patient presented late following coronary artery bypass surgery with recurrent angina. Investigations revealed a saphenous vein graft aneurysm, which subsequently formed a fistula with the right atrium. This was managed by surgical excision and repair followed by regraft of the run-off territory. Intraoperatively, the left internal mammary artery, a patent graft to the left anterior descending artery, was isolated from the circulation during aortic cross-clamping by preoperative placement of a percutaneous balloon catheter within this graft. Surgery was successful and the patient was discharged symptom-free one week later.     

Giant aneurysm of a saphenous vein graft with fistulization into the right atrium: differential diagnosis and treatment]

The aneurysm of an aortocoronary saphenous vein graft is a rare but potentially fatal complication of coronary artery bypass grafting. This case came to our observation after a single episode of hypotension, followed by dyspnea in a man previously operated on for coronary artery bypass grafting. A para-hilar mass was found on routine roentgenogram. The spiral computed tomographic scan was suggestive for aortic pseudoaneurysm. The correct diagnosis was obtained by cardiac catheterization showing a giant graft aneurysm determining compression and fistulous communication into the right atrium. The difficult diagnosis and the surgical treatment are discussed.