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Ghosh B, SIbi Krishna T, Boini A, Castillo Miranda JCD, Sinha M, Bansal R, Visconti-Lopez FJ, Mesfin Girma S, Aliye Asfaw Y. Risk factors associated with saphenous vein graft aneurysm after coronary artery bypass graft. Ann Med Surg (Lond) 2023; 85:5604-5610. [PMID: 37915629 PMCID: PMC10617862 DOI: 10.1097/ms9.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Saphenous vein graft aneurysm (SVGA) is a rare but life-threatening complication following coronary artery bypass grafting (CABG). The authors aim to identify the potential risk factors that lead to SVGA in post-CABG patients. Methods A systematic review of original studies, observational studies, systematic reviews, meta-analyses, case studies, and case series was conducted using PubMed, Web of Science, Scopus, EMBASE, and Google Scholar involving adult patients (>18) with SVGA after CABG using MESH terminology in a broad search strategy. All searches were performed and analyzed according to PRISMA and duplicates were removed via Rayyan. Two independent investigators extracted and assessed the data involving demographics, and baseline data related to CABG and its manifestations. Results Out of 487 finalized articles, 14 of them matched the inclusion requirements and reported 12 cases of SVGAs following CABG. Atherosclerosis with intimal calcification was the most common risk factor followed by infection. Others included hyperlipidemia, pneumonia, and cardiac pathologies mostly related to the ventricles and valves. Conclusion Atherosclerosis associated with intimal calcification is the most common risk factor. Patient outcomes seem to improve upon early identification and regular follow-up imaging. The exclusion criteria indicated the study's limits, and future studies that address these constraints may be able to better understand the risk variables involved in the genesis of SVGA.
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Affiliation(s)
- Bikona Ghosh
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | | | | | - Mehul Sinha
- Kasturba Medical College, Mangalore, Karnataka, India
| | - Radha Bansal
- Government Medical College and Hospital, Chandigarh
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Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent. Case Rep Cardiol 2016; 2016:9126817. [PMID: 27110409 PMCID: PMC4826672 DOI: 10.1155/2016/9126817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/20/2016] [Indexed: 11/17/2022] Open
Abstract
An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session.
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Young A, Cheng R, Wei J, Esmailian F, Currier J, Azarbal B. Prevalence of coronary artery fistulae after cardiac surgery. Comparison between coronary artery bypass grafting, valve surgery, and orthotopic heart transplantation. Herz 2014; 40 Suppl 1:51-5. [PMID: 24577076 DOI: 10.1007/s00059-014-4053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/12/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Coronary artery fistulae (CAF) are anomalous connections from a coronary artery to a recipient pulmonary vessel or cardiac chamber, and are reported in 0.2 % of the general population. The prevalence of CAF in the modern orthotopic heart transplant (OHT) population has been demonstrated to be significantly higher. The mechanism is unknown but one proposal is endothelial and vascular growth factor activation from injury. We hypothesize an incremental increase in CAF prevalence with the complexity of surgery, such that patients who have undergone OHT surgery would have an increased prevalence of CAF, as compared with patients who have undergone coronary artery bypass (CABG) surgery with valve surgery and as compared with patients who have undergone CABG surgery only. PATIENTS AND METHODS Consecutive angiograms of 481 patients after CABG surgery and 432 patients after OHT were reviewed. Patients who had previous valve surgery in addition to CABG were identified. Presence of CAF was determined. The chi-squared test was used for statistical analysis. RESULTS In all, 436 patients had CABG only (group A), 45 patients had CABG with valve surgery (group B), and 432 patients had OHT (group C). The mean age of patients at the time of surgery for group A, B, and C was 59.0, 66.1, and 55.3 years, respectively. The percentage of male patients was 78.4, 77.8, and 77.1 %, respectively. We found 10 patients (2.3 %) with CAF in group A compared with 4 patients (8.9 %) in group B, and 88 patients (20.4 %) in group C, which was statistically significant (p < 0.001). All CAF were small, were not associated with hemodynamic compromise or significant adverse events, and were managed conservatively. CONCLUSION There is an increased prevalence of CAF formation both after CABG and OHT compared with the general population. The higher prevalence of CAF in patients who additionally underwent valve surgery or who underwent OHT may be attributed to differences in surgical complexity. The increased prevalence of CAF formation after OHT compared with CABG should be further investigated.
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Affiliation(s)
- A Young
- Cedars-Sinai Heart Institute, 8536 Wilshire Blvd 302, 90211, Los Angeles, California, USA
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Ali N, Mathew T, Henderson R, Agostoni P, Werner N. How should I treat an asymptomatic enlarging giant saphenous vein graft aneurysm? EUROINTERVENTION 2014; 9:1244-7. [PMID: 24561741 DOI: 10.4244/eijv9i10a209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nadine Ali
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom
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Large aneurysm in saphenous vein coronary artery graft with fistula: case report and review. Gen Thorac Cardiovasc Surg 2013; 63:293-7. [PMID: 23881434 DOI: 10.1007/s11748-013-0292-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
Aneurysms developing in a saphenous vein graft (SVG) after coronary artery bypass grafting (CABG) are an unusual complication and fistulae forming between an SVG aneurysm and a cardiac chamber are even rarer. A 71-year-old man had undergone a triple CABG with the left internal thoracic artery and double SVGs. Twenty years later, he was admitted with repeated congestive heart failure. A large true aneurysm (99 × 60 mm) developed in the mid portion of a saphenous vein graft to the right coronary artery together with a fistula with a diameter of 8 mm in the right atrium. The aneurysm was surgically resected and the fistula was closed.
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Shreenivas S, Anwaruddin S. Management of Complications During Saphenous Vein Graft Interventions. Interv Cardiol Clin 2013; 2:339-346. [PMID: 28582140 DOI: 10.1016/j.iccl.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Because of greater patient comorbidities, more diffusely diseased vessels, and the greater possibility of mechanical complications, saphenous vein graft interventions are fraught with complications. The greatest risk is a higher risk of periprocedural myocardial infarction due to distal embolization of microemboli. The risk for noreflow in a patient with concomitant native critical vessel disease can have grave consequences. Minimizing the risk of periprocedural myocardial infarction with the use of distal embolic protection, understanding the role of adjunctive pharmacotherapy, and learning how to manage less common but serious mechanical complications during saphenous vein graft interventions are important to ensure optimal patient outcomes.
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Affiliation(s)
- Satya Shreenivas
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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7
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Stent-graft repair of a giant saphenous vein graft aneurysm. Heart Lung Circ 2012; 21:828-30. [DOI: 10.1016/j.hlc.2012.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 04/16/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature. Case Rep Cardiol 2012; 2012:652086. [PMID: 24826267 PMCID: PMC4008282 DOI: 10.1155/2012/652086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/18/2012] [Indexed: 11/18/2022] Open
Abstract
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.
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El Hosieny A, Hui W. Fistula between right coronary artery vein graft and right atrium as an immediate complication of percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 80:71-4. [PMID: 22234898 DOI: 10.1002/ccd.23371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/25/2011] [Indexed: 11/09/2022]
Abstract
Fistula between saphenous vein graft (SVG) and a cardiac chamber or structure is a rare complication after coronary artery bypass grafting (CABG). We report the first case of a fistula between SVG and the right atrium (RA) as an immediate complication after a percutaneous coronary intervention (PCI) in an 86-year-old female. She presented with inferior ST-elevation myocardial infarction (STEMI) and was treated with thrombolytic therapy in a peripheral hospital, which was unsuccessful. PCI to SVG to the right coronary (RCA) was complicated by a fistula to RA. Cardiac magnetic resonance (CMR) confirmed the site of the fistula and also presence of a significant arteriovenous (AV) shunt. Reversal of anticoagulation had no effect on fistula closure. Therefore, a covered stent was deployed for closure of the fistula to avoid long-term complications of the significant AV shunt. In summary, the diagnosis and appropriate management of this rare complication is challenging, but excellent result can be achieved by the use of appropriate percutaneous techniques.
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Affiliation(s)
- Adel El Hosieny
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure. Cardiovasc Interv Ther 2010; 26:147-52. [DOI: 10.1007/s12928-010-0044-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 10/12/2010] [Indexed: 11/28/2022]
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Fistula From Aneurysmal Saphenous Vein Graft to Right Atrium Treated with Covered Stents. Heart Lung Circ 2010; 19:465-9. [DOI: 10.1016/j.hlc.2010.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 04/04/2010] [Accepted: 05/03/2010] [Indexed: 11/17/2022]
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Sareyyupoglu B, Schaff HV, Ucar I, Sundt TM, Dearani JA, Park SJ. Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization. Ann Thorac Surg 2009; 88:1801-5. [DOI: 10.1016/j.athoracsur.2009.07.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/26/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
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Bhindi R, Newton J, Westaby S, Wilson N, Ormerod OJ, Uberoi R. Stent-graft repair of coronary vein graft aneurysm. J Vasc Interv Radiol 2009; 20:649-51. [PMID: 19339201 DOI: 10.1016/j.jvir.2009.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 01/28/2009] [Accepted: 02/02/2009] [Indexed: 10/20/2022] Open
Abstract
The authors describe treating a 6-cm right coronary artery bypass graft aneurysm that was causing recurrent angina. With use of the combined skills of interventional radiologists and cardiologists, the aneurysm was successfully occluded by using a stent-graft typically used to treat aneurysms in the peripheral circulation. One month after the procedure, the aneurysm had sealed at follow-up computed tomographic angiography.
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Affiliation(s)
- Ravinay Bhindi
- Department of Cardiology, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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Carasso S, Sternik L, Kuperstein R, Feinberg MS. A Large Saphenous Vein Graft Aneurysm Presenting as a Right Atrial Mass: A Case Report. Echocardiography 2006; 23:499-502. [PMID: 16839389 DOI: 10.1111/j.1540-8175.2006.00248.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Shemy Carasso
- The Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.
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Ivert T, Orre L. Right Thoracotomy for Saphenous Vein Graft Aneurysm Causing Hemoptysis. Ann Thorac Surg 2006; 81:1885-7. [PMID: 16631696 DOI: 10.1016/j.athoracsur.2005.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 05/09/2005] [Accepted: 05/10/2005] [Indexed: 11/25/2022]
Abstract
Hemoptysis and septicemia 6 years after coronary artery bypass surgery in a 56-year-old man was caused by a 5-cm vein graft pseudoaneurysm bleeding into the right pleura and lung parenchyma. The graft was approached through a right thoracotomy. The patient suffered postoperative neuromyopathy, but fully recovered within 6 months without muscular, respiratory, or cardiac symptoms.
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Affiliation(s)
- Torbjörn Ivert
- Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Almanaseer Y, Rosman HS, Kazmouz G, Giraldo AA, Martin J. Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray. Cardiology 2005; 104:150-5. [PMID: 16127273 DOI: 10.1159/000087766] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 03/15/2005] [Indexed: 11/19/2022]
Abstract
Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm. We report 1 case and review 107 cases published since 1975. Severe SVG dilatations are large (6 +/- 3 cm), occur remote from surgery (12 +/- 4 years) and are life threatening, with 15.7% in-hospital mortality. Symptoms are nonspecific and the abnormality is initially observed by chest X-ray in 57% of cases. The chest X-ray abnormalities have a distinctive appearance that may suggest both diagnosis and which SVG is involved. Diagnosis is made clinically by imaging, i.e. computed tomography, echocardiography, magnetic resonance and/or surgical observation (66 cases), or most accurately by tissue evaluation by the pathologist (42 cases). Aneurysm is more common than pseudoaneurysm by a 6:1 ratio.
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Affiliation(s)
- Yassar Almanaseer
- Division of Cardiology, St. John Hospital and Medical Center, Detroit, Mich., USA
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Williams ML, Rampersaud E, Wolfe WG. A man with saphenous vein graft aneurysms after bypass surgery. Ann Thorac Surg 2004; 77:1815-7. [PMID: 15111195 DOI: 10.1016/s0003-4975(03)01144-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2003] [Indexed: 11/21/2022]
Abstract
Saphenous vein graft (SVG) aneurysms are a rare complication of coronary artery bypass graft surgery. Patients in whom these aneurysms form a fistula with either a cardiac chamber or mediastinal vessel are even more uncommon and present a difficult diagnostic and therapeutic challenge. We present a patient with SVG aneurysms and a fistula to the left atrium.
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Fares W, Sharifi M, Steele R, Sarhill N, Sopko J, Ramana CV, Koch JM. Superior vena cava syndrome secondary to saphenous venous graft aneurysm with right atrial fistula. Catheter Cardiovasc Interv 2003; 60:45-7. [PMID: 12929103 DOI: 10.1002/ccd.10601] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mega-aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare complications of bypass surgery. We report the development of superior vena cava syndrome secondary to an SVG mega-aneurysm with concomitant fistulous communication to the right atrium. Successful treatment was achieved by coil embolization and chronic anticoagulation.
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Affiliation(s)
- Wassim Fares
- Department of Cardiology, St. Vincent Charity Hospital, Case Western Reserve University and the University Hospitals of Cleveland, Cleveland, Ohio 44195, USA.
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Dabboussi M, Saade YA, Poncet A, Baehrel B. Fistula between a saphenous vein graft aneurysm and the pulmonary artery trunk. Ann Thorac Surg 2001; 71:1356-8. [PMID: 11308194 DOI: 10.1016/s0003-4975(00)01900-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the case of a 52-year-old man who was admitted for atypical thoracic pain 18 years after a saphenous vein bypass graft of the left anterior descending coronary artery. Investigations demonstrated an aneurysm of the middle portion of the vein graft with a fistulous communication to the pulmonary artery trunk. The aneurysm was excised surgically, and the fistula was closed with an autogenous pericardial patch.
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Affiliation(s)
- M Dabboussi
- Department of Thoracic and Cardiovascular Surgery, Robert Debré Hospital, Reims, France.
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