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Mezzetti E, Maiese A, Spina F, Del Duca F, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Fineschi V. Early Saphenous Vein Graft Aneurysm Rupture: A Not So-Late Complication. Case Report and Comprehensive Literature Review. Biomedicines 2023; 11:biomedicines11010220. [PMID: 36672728 PMCID: PMC9855650 DOI: 10.3390/biomedicines11010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Saphenous vein graft (SVG) is a cardiac surgical practice used to create a cardiac bypass in cases of coronary artery obstruction. It consists of a surgical procedure that involves the creation of an aorto-coronary communication by a venous conduit (saphenous vein) to bypass coronary stenosis and allow cardiac revascularization. This practice can be affected by early and late complications. The most feared complication is graft aneurysm or pseudoaneurysm degeneration and rupture which are considered late complications. This paper presents a rare case of SVG aneurysmal rupture that occurred 24 h after surgery and a review of the literature to provide a general look at the state of knowledge. MATERIALS AND METHODS The systematic review was carried out using the guidelines according to the PRISMA method. RESULTS Cases of aneurysmal rupture have never been described prior to one month after surgery. The male sex and subjects under 45 are the most affected by this complication. Death occurs in less than half of the cases, being more frequent in young people. Performing a CT or angio-CT examination led to the diagnosis. CONCLUSIONS It is impossible to estimate the implanted vessel's quality, so postoperative follow-up is fundamental. Transesophageal ultrasound can be useful, and hematochemical tests are valuable early diagnostic tools, whrease CT and angio-CT can be useful even months after surgery. Forensic analysis should always perform an autopsy and graft histological examination.
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Affiliation(s)
- Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Federica Spina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
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2
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Bansal RC, Lafian H, Kirk S. Aortocoronary Saphenous Vein Graft Aneurysm: Diagnosis Using Color Doppler and Contrast Transesophageal Echocardiography. CASE 2021; 5:368-372. [PMID: 34993365 PMCID: PMC8712998 DOI: 10.1016/j.case.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ramesh C. Bansal
- Department of Cardiology, Loma Linda University, Loma Linda, California
- Reprint requests: Ramesh C. Bansal, MD, FASE, Professor of Medicine, Director, Adult Echocardiography Laboratory Loma Linda University School of Medicine 11234 Anderson Street, Troesh Medical Campus (TMC), Room MC-1B-255, Loma Linda, CA 92354.
| | - Haig Lafian
- Department of Cardiology, Loma Linda University, Loma Linda, California
| | - Shannon Kirk
- Department of Radiology, Loma Linda University, Loma Linda, California
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3
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Henn MC, Henn LW. Spontaneous Rupture of an Aortocoronary Saphenous Vein Graft Aneurysm. Tex Heart Inst J 2015; 42:405-6. [PMID: 26413031 DOI: 10.14503/thij-14-4634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Khan H, Chaubey S, Jakaj G, Kumar S, John L. A giant saphenous vein graft aneurysm causing left internal mammary artery to left anterior descending artery graft compression. Am J Cardiol 2013; 112:1840-1. [PMID: 24063824 DOI: 10.1016/j.amjcard.2013.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
Saphenous vein graft aneurysm is a rare complication after coronary artery bypass surgery. It is defined as a localized dilatation of the vessel to 1.5× the expected normal diameter. We report a case of 67-year-old man who presented with angina 23 years after coronary artery bypass graft. He was found to have a giant saphenous vein graft aneurysm to diagonal artery compressing the left internal mammary artery graft to the left anterior descending artery. The patient underwent aneurysm resection with satisfactory outcome.
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5
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Salcedo JD, Bhakta MD, Kern MJ. Aortocoronary saphenous vein graft rupture during diagnostic angiography. Catheter Cardiovasc Interv 2013; 82:230-4. [PMID: 23008157 DOI: 10.1002/ccd.24661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 09/05/2012] [Accepted: 09/16/2012] [Indexed: 11/10/2022]
Abstract
Coronary saphenous vein graft (SVG) rupture during diagnostic angiography is a very rare but known complication of the procedure. It has typically been reported to occur at the site of pseudoaneurysms or secondary to an interventional procedure involving the graft. We present a case of SVG mid-body rupture during diagnostic angiography that occurred without evidence of pseudoaneurysmal changes.
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Affiliation(s)
- Jonathan D Salcedo
- Department of Cardiology, University of California, Irvine Medical Center, Irvine, California, USA
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6
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Komai H, Shigematsu H, Obitsu Y, Ogawa T, Nagao T. Spontaneous Rupture of Autogenous Saphenous Vein Graft in Bypass Surgery for Peripheral Arterial Disease Possibly Associated With Collagen Disease. Ann Vasc Surg 2012; 26:1013.e9-1013.e12. [DOI: 10.1016/j.avsg.2012.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 01/27/2012] [Accepted: 02/12/2012] [Indexed: 11/28/2022]
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7
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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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8
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Taguchi E, Sawamura T, Kamio T, Fukunaga T, Oe Y, Miyamoto S, Koyama J, Tayama S, Sakamoto T, Nishigami K, Honda T, Hirayama T, Nakao K. An autopsy case of the rupture of a giant aneurysm in a saphenous vein graft: 18 years after CABG. J Cardiol Cases 2010; 2:e88-e91. [PMID: 30524595 DOI: 10.1016/j.jccase.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 03/25/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022] Open
Abstract
The saphenous vein is a widely used blood vessel for arterial bypass procedures. Failures of saphenous vein aortocoronary bypass grafts are predominantly the result of subsequent vein graft atherosclerotic disease. Rarely saphenous vein grafts undergo aneurysmal degeneration. This report describes a case of a ruptured aneurysm in a saphenous vein graft that occurred in an 82-year-old female who underwent a coronary artery bypass operation 18 years previously. We could not resuscitate her, but describe the autopsy findings in detail.
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Affiliation(s)
- Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Tadashi Sawamura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Takihiro Kamio
- Division of Pathology, Saiseikai Kumamoto Hospital Laboratory Center, Kumamoto, Japan
| | - Takashi Fukunaga
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Yoko Oe
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Shinzo Miyamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Shinji Tayama
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Kazuhiro Nishigami
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Toshihiro Honda
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Touitsu Hirayama
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
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9
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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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10
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A saphenous vein graft aneurysm with fistula development to the right atrium: surgical management of a rare bypass graft complication. Can J Cardiol 2009; 24:915-6. [PMID: 19052672 DOI: 10.1016/s0828-282x(08)70699-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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11
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Abstract
We report a case of a 75-year-old man suffering from a covered perforated aneurysm of a saphenous bypass graft to the right coronary artery (RCA) constructed 22 years ago. Additional complete revascularization had been performed in 2001. A thoracic computed tomography scan for evaluation of fever of unknown origin had revealed a huge hematoma in front of the right heart. Coronary angiography showed open bypasses but an irregular-shaped aneurysm of the venous graft to the RCA right before the distal anastomosis. Occurrence of a new right-sided pleural effusion led to the emergent operation since rupture of the aneurysm and drainage into the pleura was likely. A massive precordial hematoma was found and the existence of the perforated aneurysm could be confirmed. After institution of cardiopulmonary bypass the graft was resected. Since the patient had a functioning bypass to the RIVP, there was no need for additional revascularization. The patient underwent an uneventful postoperative course.
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Affiliation(s)
- Sebastian Holinski
- Department of Cardiovascular Surgery, Charité, Universitätsmedizin, Berlin, Germany.
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12
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Saphenous vein graft angioplasty pseudoaneurysm: A surgical challenge. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Bittar MN, Duncan AJ. Off-pump resection of aorto-saphenous vein graft pseudoaneurysm. Asian Cardiovasc Thorac Ann 2007; 15:157-8. [PMID: 17387201 DOI: 10.1177/021849230701500216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Mohamad N Bittar
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom.
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14
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Montani D, Wagner T, Kraoua S, Honoré I, Lacronique J, Dusser D. L’anévrysme de pontage aortocoronaire veineux : une cause rare de masse médiastinale. Presse Med 2007; 36:67-8. [PMID: 17261452 DOI: 10.1016/j.lpm.2006.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- David Montani
- Service de Pneumologie, Hôpital Cochin, Université Paris V, AP-HP, Paris.
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15
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Krishnasamy P, Gillespie JSJ, McGlinchey PG, Khan MM, Adgey AAJ. Giant true saphenous vein graft aneurysm causing cardiac compression: a rare cause of atrial flutter. Int J Cardiol 2006; 121:317-9. [PMID: 17187882 DOI: 10.1016/j.ijcard.2006.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 08/31/2006] [Accepted: 11/02/2006] [Indexed: 11/29/2022]
Abstract
A 67 year old man presented with new-onset atrial flutter. He had a history of coronary artery bypass graft (CABG) surgery on two occasions. Subsequent investigation revealed the presence of a large saphenous vein graft (SVG) aneurysm compressing the right heart. We postulate that the SVG aneurysm was the precipitating cause for the atrial flutter. This case is the first in the literature to document an atrial arrhythmia as the presenting feature of a SVG aneurysm.
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16
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Jouve B, Rahal Y, Lenaers C, Maurice R, Alfares A, Benchaa T, Taieb J, Pizigo E, Le Treut J, Barnay C. [Aneurysm of a saphenous vein bypass graft to coronary artery: a case report discovered as an incidental finding]. Ann Cardiol Angeiol (Paris) 2006; 55:230-2. [PMID: 16922175 DOI: 10.1016/j.ancard.2005.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a case of aortocoronary bypass graft aneurysm revealed by exertional dyspnea and presenting as an anterior mediastinal mass at the unenhanced computed tomography scan. The diagnosis has been established using combined contrast-enhanced CT scan which specified the vascular nature of the mass and coronary angiography which connected it to the aorto-marginal branch saphenous vein graft. This case illustrates the frequently asymptomatic expression of aneurysm and the importance of combined imaging modalities for the diagnosis.
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Affiliation(s)
- B Jouve
- Service de cardiologie du Dr-Barnay, centre hospitalier du Pays-d'Aix, 13100 Aix-en-provence, France
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17
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Hoffer E, Materne P, Beckers J, Marenne F, Henroteaux D, Boland J. Endovascular treatment of a coronary artery bypass graft to right ventricle fistula with balloon embolization. Int J Cardiol 2006; 112:e50-2. [PMID: 16860419 DOI: 10.1016/j.ijcard.2006.03.071] [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: 01/12/2006] [Accepted: 03/25/2006] [Indexed: 11/29/2022]
Abstract
Fistula formation between a coronary artery bypass graft and a cardiac cavity is an uncommon finding. We describe a case of transcatheter occlusion of a coronary artery bypass graft to right ventricle fistula in a patient presenting with a subacute inferior myocardial infarction.
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18
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Sasahashi N, Ueyama K, Morishima A, Takeuchi T, Nishina T. Saphenous vein graft rupture eighteen years after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2006; 54:178-81. [PMID: 16642927 DOI: 10.1007/bf02662476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Delayed saphenous vein graft (SVG) rupture following coronary artery bypass graft (CABG) is an unusual but potentially fatal complication. Herein we report a case of SVG rupture 18 years after CABG. A 75-year-old man had undergone a CABG with SVG in 1987 at another institution. In 2004 the patient developed angina and underwent re-CABG with arterial conduits in our hospital. On the preoperative cineangiogram, the SVG to the right coronary artery (RCA) was irregularly dilated, yet still providing flow to the distal RCA. In 2005 he was readmitted to our hospital for abdominal pain. Chest computed tomography revealed a huge round mass adjacent to the heart. Cineangiogram showed leakage of the contrast in the midportion of the SVG. At operation, graft rupture was evident and repaired under cardiopulmonary bypass. Although cardiac function was well maintained, after the surgery he developed ischemic colitis and died of multiple organ failure on the 17th postoperative day.
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Affiliation(s)
- Nozomu Sasahashi
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Japan
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19
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Topaz O, Rutherford MS, Mackey-Bojack S, Prinz AW, Katta S, Salter D, Titus JL. Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. Cardiovasc Pathol 2006; 14:298-302. [PMID: 16286038 DOI: 10.1016/j.carpath.2005.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Revised: 07/18/2005] [Accepted: 08/08/2005] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Giant aneurysms that develop in native coronary arteries or saphenous vein grafts are morphologically defined as abnormally expanded outpouching vascular structures >4 cm in diameter. The location, morphology, and content of giant aneurysms account for adverse cardiovascular effects. METHODS Two cases of giant aneurysms were studied comprehensively by noninvasive and invasive cardiac methods and subsequent histopathology. The first patient had a giant aneurysm that developed over a course of several years in a saphenous vein graft whereas the second patient had a giant aneurysm occurring within a native coronary artery. Accompanying clinical and angiographic findings are described. RESULTS Atherosclerosis and thrombosis were among the prominent histopathological findings. CONCLUSIONS Atherosclerosis and associated thrombosis within giant aneurysms result in obstruction of flow, distal embolization, and development of acute coronary syndromes including recurrent ischemic chest pain, unstable angina, and acute myocardial infarction. The options for clinical management of giant coronary or vein graft aneurysms include surgical excision, percutaneous coil occlusion and stent deployment, or medical approach.
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Affiliation(s)
- On Topaz
- Division of Cardiology and Pathology, McGuire Veterans Affairs Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23249, USA.
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20
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Tubbs RS, Salter EG, Sheetz J, Zehren S, Oakes WJ. An unusual case of a mediastinal mass in a cadaver. Clin Anat 2005; 19:151-3. [PMID: 16258974 DOI: 10.1002/ca.20174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Since 1975, only approximately 60 saphenous vein graft aneurysms have been reported in the medical literature. We now report this unusual finding in a male cadaver who had undergone a recent coronary artery bypass grafting procedure. Although aneurysm formation is an unusual complication of saphenous vein graft surgery, the diagnosis must be suspected particularly in the face of a mediastinal mass on chest radiography in patients who have undergone coronary artery bypass grafting. Needle biopsy in these cases may prove lethal. We believe this to be the first description of this complication in a cadaver.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, Alabama, USA.
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21
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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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22
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Yatskar L, Rosenzweig BP, Attubato M, Axel L, Tunick PA, Kronzon I. Saphenous Vein Graft Aneurysm Masquerading as a Right Atrial Mass. Echocardiography 2005; 22:263-5. [PMID: 15725163 DOI: 10.1111/j.0742-2822.2005.04041.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a case of a large saphenous vein graft (SVG) aneurysm masquerading as a right atrial mass on transesophageal echocardiogram. Cardiac magnetic resonance angiography reliably made a diagnosis of SVG aneurysm extrinsically compressing right atrium. This case illustrates the importance of using combined imaging modalities for the diagnosis and management of cardiac masses.
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Affiliation(s)
- Leonid Yatskar
- Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, The Leon Charney Division of Cardiology, NYU School of Medicine, New York, New York 10016, USA
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23
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Mayglothling J, Thomas MP, Nyzio JB, Strong MD, Samuels LE. Aneurysm of Aortocoronary Saphenous Vein Graft:. Heart Surg Forum 2004; 7:E317-20. [PMID: 15454384 DOI: 10.1532/hsf98.20041044] [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: 11/20/2022]
Abstract
True aneurysms of aortocoronary saphenous vein bypass grafts are a relatively rare complication of bypass surgery, but because the complications of thrombosis, embolization, or rupture are potentially fatal, this condition requires immediate surgical intervention. We describe a 78-year-old man who had undergone coronary bypass 15 years previously and who presented with a saphenous vein graft that was severely degenerated and aneurysmally enlarged throughout its course, measuring as much as 5 to 6 cm in certain locations. Redo coronary artery bypass grafting using the right and left internal thoracic arteries and resection of the aneurysm were performed. We also present a review of the literature regarding diagnosis, management, and treatment of this condition.
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Affiliation(s)
- Julie Mayglothling
- Department of Cardiothoracic Surgery, The Lankenau Hospital, Wynnewood, Pennsylvania 19096, USA
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24
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Abstract
The authors present a case of a large, saphenous vein graft aneurysm, and present a detailed review of the disease.
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Affiliation(s)
- Abdul-Qadir Memon
- Department of Cardiology, University of Arizona Health Sciences Center, PO Box 245037, 1501 N. Campbell Avenue, Tucson, AZ 85724-5037, USA.
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25
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Dixon SR, Skelding KA, Frumin HI, O'Neill WW. Occlusion of a saphenous vein graft aneurysm with a vein-covered stent. J Interv Cardiol 2002; 15:201-4. [PMID: 12141145 DOI: 10.1111/j.1540-8183.2002.tb01057.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Simon R Dixon
- Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd., Royal Oak, MI 48073, USA
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26
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Abstract
A case of a 73-year-old asymptomatic man with a large saphenous vein graft aneurysm first diagnosed 16 years after bypass operation is presented. The lesion was first suspected on routine transthoracic echocardiography and further clarified by transesophageal echocardiography. Selective graft angiography confirmed the diagnosis and surgical therapy included resection of the graft aneurysm and coronary artery bypass grafting.
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Affiliation(s)
- Ramesh C Bansal
- Division of Cardiology, Loma Linda University School of Medicine, CA 92350, USA
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27
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Maier LS, Buchwald AB, Ehlers B, Rühmkorf K, Scholz KH. Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system. Catheter Cardiovasc Interv 2002; 55:109-12. [PMID: 11793506 DOI: 10.1002/ccd.10044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.
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Affiliation(s)
- Lars S Maier
- Department of Cardiology, Georg-August-Universität Göttingen, Göttingen, Germany
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28
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Gupta S, Khan T, Stephenson LW, Cooley D, Schnader J. Clinical Conference on Management Dilemmas. Chest 2000. [DOI: 10.1378/chest.108.3.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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29
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Gruberg L, Satler LF, Pfister AJ, Monsein LH, Leon MB. A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature. Catheter Cardiovasc Interv 1999; 48:214-6. [PMID: 10506784 DOI: 10.1002/(sici)1522-726x(199910)48:2<214::aid-ccd21>3.0.co;2-p] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.
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Affiliation(s)
- L Gruberg
- Cardiology Research Foundation, Department of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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30
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Kalimi R, Palazzo RS, Graver LM. Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium. Ann Thorac Surg 1999; 68:1433-7. [PMID: 10543534 DOI: 10.1016/s0003-4975(99)00848-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aneurysm of reverse aortocoronary saphenous vein graft is a known complication of coronary artery bypass grafting. In this report we present a case of a 60-year-old man who presented 12 years after coronary artery bypass grafting with a giant graft aneurysm of the reverse aortocoronary saphenous vein graft to the right coronary artery, compressing the right atrium. Spiral computed tomography was used to identify the aneurysm measuring 7 x 6 x 7 cm. We also reviewed the English-language literature and found reports of 50 patients with similar aneurysms of which 30 (61%) were identified as true aneurysms and 17 (33%) were identified as pseudoaneurysms. Three patients could not be identified into either group. We reviewed the presenting symptoms, diagnostic tools, and treatment options for this rare entity. An understanding of the pathophysiology of reverse aortocoronary saphenous vein graft aneurysm is important to prevent the possibility of aneurysm rupture, embolization, myocardial infarction, or death.
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Affiliation(s)
- R Kalimi
- Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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31
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Sharifi M, Dillon JC, Pompili VJ. Saphenous vein graft ectasia: an unusual late complication of coronary artery bypass surgery. A case report. Angiology 1999; 50:497-501. [PMID: 10378826 DOI: 10.1177/000331979905000608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aneurysms and ectasias of saphenous vein grafts are infrequent complications of coronary artery bypass surgery. They usually present as an expanding asymptomatic mediastinal mass on chest x-ray film or computed tomography scan. Though rare, they must be excluded from the differential diagnosis of mediastinal masses to avoid potentially dangerous needle biopsy. The authors describe ectasia of a saphenous vein graft in a 62-year-old man 14 years after coronary artery bypass surgery. The relevant literature is also discussed.
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Affiliation(s)
- M Sharifi
- Department of Medicine, The Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202-4800, USA
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32
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Nakamura M, Nishikawa H, Aoki T, Setsuda M, Mukai S, Yamada T, Makuuchi H, Naruse Y, Tamada H, Suzuki H, Ohnishi T, Kakuta Y, Nakano T. Late development of an aneurysm of a saphenous vein used as an aortocoronary conduit. Am J Cardiol 1999; 83:1294-5, A10. [PMID: 10215305 DOI: 10.1016/s0002-9149(99)00080-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A case of a large saphenous vein aortocoronary aneurysm that developed late after coronary artery bypass grafting is presented. This is the first case of a large saphenous vein aortocoronary aneurysm identified by serial angiography and 3-dimensional computed tomographic scanning.
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Affiliation(s)
- M Nakamura
- Division of Cardiology, Yamada Red Cross Hospital, Watarai, Mie, Japan
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33
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Trop I, Samson L, Cordeau MP, Leblanc P, Thérasse E. Anterior mediastinal mass in a patient with prior saphenous vein coronary artery bypass grafting. Chest 1999; 115:572-6. [PMID: 10027462 DOI: 10.1378/chest.115.2.572] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- I Trop
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Campus Hôtel-Dieu, Quebec, Canada
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34
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Takeuchi S, Abe H, Tanaka R, Hayashi J. Aneurysm of a subclavian-vertebral artery saphenous vein bypass graft: case report. Neurosurgery 1998; 43:1212-4. [PMID: 9802866 DOI: 10.1097/00006123-199811000-00113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Although an autogenous saphenous vein is frequently used as a bypass graft, an aneurysm of a venous graft is a rare complication, especially in the case of cerebrovascular revascularization. We report a case of a successfully treated aneurysmal change in a venous graft after short vein bypass grafting. CLINICAL PRESENTATION A 60-year-old man underwent a left subclavian-to-vertebral artery bypass operation with an interposed saphenous vein graft because of severe stenosis of the vertebral artery bilaterally. Angiograms of the left subclavian artery, obtained 4 months later, showed good patency of the graft without any dilation or stenosis. One year after the bypass surgery, the patient became aware of a pulsating mass in the left supraclavicular region, which was regarded as the grafted vein itself. A giant aneurysm of the vein graft, which developed at the nonanastomotic site, was shown in the angiogram 4 years later. INTERVENTION The aneurysm was resected, and patch grafting of the orifice of the aneurysmal neck covered with an artificial vessel as a reinforcement was performed. CONCLUSION The aneurysm seemed to have developed in a curved segment because of hemodynamic stress.
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Affiliation(s)
- S Takeuchi
- Department of Neurosurgery, School of Medicine, Niigata University, Japan
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35
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Fukui T, Suehiro S, Shibata T, Sasaki Y, Minamimura H, Kinoshita H. Aortocoronary saphenous vein graft aneurysm in redo coronary artery bypass grafting: report of a case. Surg Today 1998; 28:321-4. [PMID: 9548319 DOI: 10.1007/s005950050131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report herein the case of an 80-year-old woman who underwent successful redo coronary artery bypass grafting (CABG) for a saphenous vein graft aneurysm found 10 years after her initial operation. On presentation, coronary angiography (CAG) revealed aneurysmal dilatation of the saphenous vein graft and severe stenosis of the left main trunk (LMT). A percutaneous transluminal coronary angioplasty (PTCA) of the LMT lesion was performed; however, a CAG after the PTCA revealed restenosis and the patient developed anginal chest pain at rest. Thus, repeat CABG was urgently carried out, which was followed by a good outcome. Histological examination of the aneurysmal dilatation showed a true aneurysm. Only 15 other cases of redo CABG for this indication have been reported, the features of which are also discussed.
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Affiliation(s)
- T Fukui
- Second Department of Surgery, Osaka City University, Osaka, Japan
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36
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Wight JN, Salem D, Vannan MA, Pandian NG, Rozansky MI, Dohan MC, Rastegar H. Asymptomatic large coronary artery saphenous vein bypass graft aneurysm: a case report and review of the literature. Am Heart J 1997; 133:454-60. [PMID: 9124168 DOI: 10.1016/s0002-8703(97)70188-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J N Wight
- Department of Medicine, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, MA 02111, USA
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37
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Benari B, Erel J, Allen HN, Friedman J, Kiat H, Silverman JM, Trento A, Berman D. Aneurysm of saphenous vein bypass graft detected by first-pass radionuclide ventriculography. Am Heart J 1997; 133:133-6. [PMID: 9006303 DOI: 10.1016/s0002-8703(97)70260-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B Benari
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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38
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Nathaniel C, Missri JC. Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: a case report and review. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 38:80-2. [PMID: 8722865 DOI: 10.1002/(sici)1097-0304(199605)38:1<80::aid-ccd18>3.0.co;2-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm. A review of pseudoaneurysms of aortocoronary bypass grafts is presented.
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Affiliation(s)
- C Nathaniel
- St. Francis Hospital and Medical Center, Hoffman Heart Institute of Connecticut, Hartford 06105, USA
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39
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Sahouri SJ, Steele RL. Aneurysm of saphenous vein graft to coronary artery presenting as non-Q-wave myocardial infarction secondary to mass effect. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:325-8. [PMID: 7621543 DOI: 10.1002/ccd.1810340211] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Large aneurysms (> 4 cm) of saphenous vein grafts (SVG) to coronary arteries are a rare complication of coronary artery bypass graft surgery (CABG). A 64-year-old male, status post-CABG 14 years ago, presented with dyspnea and diaphoresis. Pneumonia and non-Q-wave myocardial infarction (MI) were diagnosed. Cardiac catheterization and chest computed tomography demonstrated a 5 x 7-cm aneurysm of a SVG. At the time of surgery, the left internal mammary artery (grafted to the left anterior descending artery) was found to be stretched tautly over the aneurysm, resulting in impaired flow. The aneurysm was successfully resected. This is the first published case implicating a SVG aneurysm as the direct cause of a MI by mass effect.
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Affiliation(s)
- S J Sahouri
- St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
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40
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Kallis P, Keogh BE, Davies MJ. Pseudoaneurysm of aortocoronary vein graft secondary to late venous rupture: case report and literature review. Heart 1993; 70:189-92. [PMID: 8038033 PMCID: PMC1025284 DOI: 10.1136/hrt.70.2.189] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Formation of pseudoaneurysms of saphenous vein grafts after coronary artery bypass grafting has been reported previously in relation to anastomoses or secondary to infection. Pseudoaneurysm of the saphenous vein graft after late rupture of the saphenous vein and containment by the obliterated pericardial cavity has not been documented. Such a case is reported and published reports of similar cases are reviewed.
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Affiliation(s)
- P Kallis
- Department of Cardiothoracic Surgery, St George's Hospital, London
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41
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Wyatt DA, Gay SB, Gimple LW, Spotnitz WD. Successful preoperative diagnosis and treatment of a saphenous vein coronary artery bypass graft aneurysm. Chest 1993; 104:283-4. [PMID: 8325085 DOI: 10.1378/chest.104.1.283] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 71-year-old man who underwent a coronary artery bypass using a saphenous vein bypass graft (SVG) in 1977 presented with a new mediastinal mass on chest radiography. A variety of imaging techniques were applied and magnetic resonance imaging (MRI) provided excellent anatomic detail of an aneurysm of the previously placed SVG. This condition was successfully treated with repeat operation, aneurysm resection, and placement of new bypass grafts. We recommend that any patient with a history of previous coronary artery grafting who presents with a mediastinal mass be evaluated for the possibility of a graft aneurysm. The best mediastinal imaging technique for this purpose appears to be an MRI scan.
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Affiliation(s)
- D A Wyatt
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908
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42
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Ennis BM, Zientek DM, Ruggie NT, Billhardt RA, Klein LW. Characterization of a saphenous vein graft aneurysm by intravascular ultrasound and computerized three-dimensional reconstruction. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1993; 28:328-31. [PMID: 8462083 DOI: 10.1002/ccd.1810280411] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aneurysmal dilatations in saphenous vein grafts are rare complications of coronary artery bypass surgery that mostly represent thin-wall pseudoaneurysms at anastomotic sites. We describe a case of an enlarging distal saphenous vein graft aneurysm in which intravascular ultrasound (IVUS) and computerized three-dimensional reconstruction (3DR) of the IVUS images was performed to conclusively demonstrate true aneurysm morphology. Although both atherosclerotic and nonatherosclerotic mechanisms for vein graft aneurysm formation have been previously suggested, IVUS images and 3DR of the aneurysm in this case did not reveal any of the features typical for atherosclerotic lesions. Further, the IVUS images and 3DR suggest that progressive atherosclerosis is not the likely cause of aneurysm formation in this case. This application of IVUS and 3DR provides detailed information about saphenous vein graft aneurysm structure, clues to aneurysm formation, and suggests a natural history that may differ from that of pseudoaneurysms.
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Affiliation(s)
- B M Ennis
- Rush Heart Institute, Chicago, Illinois
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43
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Baldwin RT, Klima T, Frazier OH, Lonquist J, Radovancevic B. True aneurysm of the saphenous vein graft stump associated with CABG in a cardiac transplant patient. Ann Thorac Surg 1992; 54:978-9. [PMID: 1417296 DOI: 10.1016/0003-4975(92)90664-p] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aneurysm of a saphenous vein graft after coronary artery bypass requires surgical resection because of its potential for rupture. This report describes a case of aneurysm formation in a 55-year-old man who underwent coronary artery bypass operation in 1977 and orthotopic heart transplantation 7 years later. A proximal vein graft remnant that had been ligated at the time of transplantation developed into a 5-cm aneurysm. In patients who have undergone previous coronary artery bypass operation, we recommend that the entire vein graft stump be excised and oversewn at the aortosaphenous anastomosis at the time of transplantation.
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Affiliation(s)
- R T Baldwin
- Section of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345
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44
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Jukema JW, van Dijkman PR, van der Wall EE. Pseudoaneurysm of a saphenous vein coronary artery bypass graft with a fistula draining into the right atrium. Am Heart J 1992; 124:1397-9. [PMID: 1442522 DOI: 10.1016/0002-8703(92)90438-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J W Jukema
- Department of Cardiology, University Hospital Leiden, The Netherlands
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45
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Rebergen SA, Kroon HM, Buis B, Kibbelaar RE. Giant true aneurysm of an aortocoronary bypass graft: a rare cause for a mediastinal mass. Eur J Radiol 1992; 15:135-7. [PMID: 1425749 DOI: 10.1016/0720-048x(92)90139-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S A Rebergen
- Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
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46
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Hughes MM, Rice TW, Simpfendorfer C. Aneurysmal saphenous vein graft presenting as an anterior mediastinal mass. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 24:265-7. [PMID: 1756561 DOI: 10.1002/ccd.1810240409] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 58-year-old male presented with an anterior mediastinal mass which was found to be secondary to an aneurysmal dilatation of the saphenous vein graft to his circumflex artery. This represents an unusual presentation of an aneurysmally dilated saphenous vein graft.
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Affiliation(s)
- M M Hughes
- Department of Cardiology, Cleveland Clinic Foundation, OH 44195
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47
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Werthman PE, Sutter FP, Flicker S, Goldman SM. Spontaneous, late rupture of an aortocoronary saphenous vein graft. Ann Thorac Surg 1991; 51:664-6. [PMID: 2012430 DOI: 10.1016/0003-4975(91)90335-n] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P E Werthman
- Division of Thoracic Surgery and Cardiovascular Surgery, Lankenau Hospital and Medical Research Center, Philadelphia, Pennsylvania 19151
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48
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Cujec B, Bharadwaj B, Chait P, Hayton R. Dehiscence of the proximal anastomosis of aortocoronary bypass graft. Am Heart J 1990; 120:1217-20. [PMID: 2239675 DOI: 10.1016/0002-8703(90)90140-s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- B Cujec
- Department of Medicine, University Hospital, Saskatoon, Saskatchewan, Canada
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49
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Rosin MD, Ridley PD, Maxwell PH. Rupture of a pseudoaneurysm of a saphenous vein coronary arterial bypass graft presenting with superior caval venous obstruction. Int J Cardiol 1989; 25:121-3. [PMID: 2793250 DOI: 10.1016/0167-5273(89)90171-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We describe the first reported case of rupture of a pseudoaneurysm of a sapheneous vein coronary arterial bypass graft presenting with acute superior caval venous obstruction. The patient was successfully treated by urgent surgical excision of the graft.
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Affiliation(s)
- M D Rosin
- Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, U.K
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50
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Goldfarb A, Danilowicz D, Friedman DM, Gluck R, Rumancik WM, Kronzon I. Massive aneurysmal dilatation of saphenous vein grafts used for systemic-pulmonary artery shunts: a role for magnetic resonance imaging in diagnosis. Am Heart J 1988; 116:870-3. [PMID: 3414502 DOI: 10.1016/0002-8703(88)90352-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- A Goldfarb
- Department of Medicine, New York University Medical Center, NY 10016
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