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Szafron JM, Heng EE, Boyd J, Humphrey JD, Marsden AL. Hemodynamics and Wall Mechanics of Vascular Graft Failure. Arterioscler Thromb Vasc Biol 2024; 44:1065-1085. [PMID: 38572650 PMCID: PMC11043008 DOI: 10.1161/atvbaha.123.318239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
Blood vessels are subjected to complex biomechanical loads, primarily from pressure-driven blood flow. Abnormal loading associated with vascular grafts, arising from altered hemodynamics or wall mechanics, can cause acute and progressive vascular failure and end-organ dysfunction. Perturbations to mechanobiological stimuli experienced by vascular cells contribute to remodeling of the vascular wall via activation of mechanosensitive signaling pathways and subsequent changes in gene expression and associated turnover of cells and extracellular matrix. In this review, we outline experimental and computational tools used to quantify metrics of biomechanical loading in vascular grafts and highlight those that show potential in predicting graft failure for diverse disease contexts. We include metrics derived from both fluid and solid mechanics that drive feedback loops between mechanobiological processes and changes in the biomechanical state that govern the natural history of vascular grafts. As illustrative examples, we consider application-specific coronary artery bypass grafts, peripheral vascular grafts, and tissue-engineered vascular grafts for congenital heart surgery as each of these involves unique circulatory environments, loading magnitudes, and graft materials.
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Affiliation(s)
- Jason M Szafron
- Departments of Pediatrics (J.M.S., A.L.M.), Stanford University, CA
| | - Elbert E Heng
- Cardiothoracic Surgery (E.E.H., J.B.), Stanford University, CA
| | - Jack Boyd
- Cardiothoracic Surgery (E.E.H., J.B.), Stanford University, CA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT (J.D.H.)
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2
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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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3
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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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4
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Ruggerini S, Pavasini R, Quagliara TAP, Fiorani V. Case report: asymptomatic pseudoaneurysm of the native coronary soon after the graft anastomosis treated with off-pump repair. Eur Heart J Case Rep 2022; 6:ytac014. [PMID: 35295729 PMCID: PMC8922691 DOI: 10.1093/ehjcr/ytac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Background Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy. Case summary A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed. Discussion The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication.
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Affiliation(s)
- Sara Ruggerini
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Teresa A P Quagliara
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Vinicio Fiorani
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
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Vinciguerra M, Spadaccio C, Tennyson C, Karuppannan M, Bose A, Greco E, Rose D. Management of Patients With Aortocoronary Saphenous Vein Graft Aneurysms: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2236-2253. [PMID: 33926660 DOI: 10.1016/j.jacc.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
Saphenous vein graft aneurysms (SVGAs) following coronary artery bypass grafting (CABG) surgery were first described in 1975. Although rare, in the absence of a prompt diagnosis, SVGAs can be responsible for serious complications and adverse outcomes. The clinical presentation of SVGAs described in the literature can vary from an asymptomatic patient with an incidental radiological finding to a profoundly shocked patient with life-threatening hemorrhage secondary to SVGA rupture. Improvements in diagnostic tools within the last decade, such as multislice computed tomographic scanning, has enabled early detection of SVGAs, and therefore, an expansion of the current management options. In this review, the current data and knowledge about clinical presentation, diagnosis, natural history, and treatment of SVGAs are updated, with a specific emphasis on the evolution of management strategies of this rare complication over the last 45 years. Finally, a clinical algorithm to guide decision-making and management is proposed.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Charlene Tennyson
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Mukesh Karuppannan
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Amal Bose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - David Rose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.
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Rahman MN, Khan BK, Hasan BS. Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass. Catheter Cardiovasc Interv 2019; 94:984-988. [PMID: 31424620 DOI: 10.1002/ccd.28441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
| | - Bilal K Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Babar S Hasan
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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7
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Acute chest pain with elevated troponin due to rupture of previously stented saphenous vein graft aneurysm. Diagn Interv Imaging 2016; 97:1183-1185. [DOI: 10.1016/j.diii.2016.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
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Park SJ, Park JY, Jung J, Hong YS, Lee CJ, Lim SH. Vanishing Venous Coronary Artery Bypass Grafts after Sepsis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:387-391. [PMID: 27734001 PMCID: PMC5059127 DOI: 10.5090/kjtcs.2016.49.5.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication.
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Affiliation(s)
- Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Ji Ye Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - You Sun Hong
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Cheol Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Sang Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
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9
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Shammas NW, Chammas MZ, Robken J, Geiss D. Percutaneous Closure of the Aorto-Ostial Origin of a Coronary Artery Saphenous Bypass Graft with a Large Pseudoaneurysm Using the AMPLATZER Muscular Ventricular Septal Defect Occluder. Int J Angiol 2016; 26:196-200. [PMID: 28804238 DOI: 10.1055/s-0036-1593446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We report the case of a 76-year-old male patient with a history of coronary artery bypass graft surgery presented with a large pseudoaneurysm emerging from a previously occluded saphenous bypass graft (SVG). A largely contained hematoma is seen in the mediastinum on computed tomography angiography (CTA) of the chest. Flow was seen from the ascending aorta into the pseudoaneurysm through the aorto-ostial opening of the bypass graft. Closure of the aorto-ostial origin of the graft was performed using the AMPLATZER muscular ventricular septal defect (VSD) occluder (St Jude's Medical, St. Paul, MN) with immediate interruption of flow into the graft and the pseudoaneurysm. A repeat CTA of the ascending aorta at 6 months postprocedure continued to confirm an optimal positioning of the occluder with no flow into the pseudoaneurysm. This case offers an endovascular alternative to close the aorto-ostial opening of a saphenous bypass graft in the setting of a rare but potentially life-threatening SVG pseudoaneurysm.
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Affiliation(s)
| | | | - Jon Robken
- Cardiovascular Medicine, PC, Davenport, IA
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10
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Gurbuz AS, Ozturk S, Acar E, Efe SC, Kilicgedik A, Kirma C. Saphenous vein graft aneurysm: A case report. ARYA ATHEROSCLEROSIS 2016; 12:100-3. [PMID: 27429630 PMCID: PMC4933749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND Saphenous vein graft aneurysms (SVGAs) are rare seen issues after coronary artery bypass graft (CABG) operation which may lead to major complications including compression of adjacent structure, myocardial ischemia, rupture, and even death. CASE REPORT We report a patient with recurrent SVGA and its treatment by percutaneous intervention with a covered stent, the diagnostic and treatment procedure were based on contrast enhanced computed tomography and myocardial perfusion scintigraphy (MPS). CONCLUSION Multimodality imaging is required to demonstrate the true size and complications of the SVGA, the relationship among the adjacent structure, and to assess ischemia and size of myocardial territory supplied by the aneurysmal graft to decide treatment strategy.
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Affiliation(s)
- Ahmet Seyfeddin Gurbuz
- General Practitioner, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey,Correspondence to: Ahmet Seyfeddin Gurbuz,
| | - Semi Ozturk
- General Practitioner, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Emrah Acar
- General Practitioner, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Suleyman Cagan Efe
- General Practitioner, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Alev Kilicgedik
- General Practitioner, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Cevat Kirma
- Assistant Professor, Kartal Kosuyolu Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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11
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Baydoun A, Sabeh MK, Abdul Rahman R, Park SJ, Parikh SA. Saphenous vein graft aneurysm presenting as abdominal pain. Am J Cardiol 2015; 115:1619-20. [PMID: 25891990 DOI: 10.1016/j.amjcard.2015.03.001] [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: 10/28/2014] [Revised: 03/14/2015] [Accepted: 03/14/2015] [Indexed: 11/27/2022]
Abstract
Aneurysmal dilation of a saphenous vein aortocoronary graft remains a rare complication. We report a patient with saphenous vein graft aneurysm who presented with abdominal pain due to compression of the adjacent liver 43 years after the coronary bypass operation.
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12
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Smer A, Alla V, Chandraprakasam S, Abuzaid A, Saurav A, Holmberg J. Saphenous Venous Graft Pseudoaneurysm: A Review of the Literature. J Card Surg 2014; 30:70-3. [DOI: 10.1111/jocs.12469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aiman Smer
- Cardiology Department; Creighton University Medical Center; Omaha Nebraska
| | - Venkata Alla
- Cardiology Department; Creighton University Medical Center; Omaha Nebraska
| | | | - Ahmed Abuzaid
- Cardiology Department; Creighton University Medical Center; Omaha Nebraska
| | - Alok Saurav
- Cardiology Department; Creighton University Medical Center; Omaha Nebraska
| | - Jeffery Holmberg
- Cardiology Department; Creighton University Medical Center; Omaha Nebraska
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Hagisawa K, Saito A, Kinoshita M, Fujie T, Otani N, Shono S, Park YK, Takeoka S. Effective control of massive venous bleeding by “multioverlapping therapy” using polysaccharide nanosheets in a rabbit inferior vena cava injury model. J Vasc Surg Venous Lymphat Disord 2013; 1:289-97. [DOI: 10.1016/j.jvsv.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/26/2013] [Accepted: 04/05/2013] [Indexed: 11/29/2022]
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14
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Ramirez FD, Hibbert B, Simard T, Pourdjabbar A, Wilson KR, Hibbert R, Kazmi M, Hawken S, Ruel M, Labinaz M, O'Brien ER. Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms. Circulation 2012; 126:2248-56. [DOI: 10.1161/circulationaha.112.101592] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- F. Daniel Ramirez
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Benjamin Hibbert
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Trevor Simard
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Ali Pourdjabbar
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Kumanan R. Wilson
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Rebecca Hibbert
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Mustapha Kazmi
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Steven Hawken
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Marc Ruel
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Marino Labinaz
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Edward R. O'Brien
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
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15
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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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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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17
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Nonatherosclerotic Cardiovascular Findings on MDCT Coronary Angiography: A Selection of Abnormalities. AJR Am J Roentgenol 2008; 190:934-46. [DOI: 10.2214/ajr.07.2830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Tonelli AR, Desai AK, Anderson RD. Treatment of a ruptured saphenous vein graft pseudoaneurysm using a vascular plug. Catheter Cardiovasc Interv 2008; 71:587-9. [DOI: 10.1002/ccd.21456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Singh SK, Sharma AK. Right hemothorax from leaking aortocoronary vein graft giant aneurysm. Asian Cardiovasc Thorac Ann 2006; 14:336-7. [PMID: 16868111 DOI: 10.1177/021849230601400415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aneurysm of the saphenous vein aortocoronary bypass graft is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We report a case of an aneurysm of the saphenous vein aortocoronary bypass graft presented 7 years after redo CABG, with features of right atrial compression and right hemothorax. The patient was successfully treated surgically.
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Affiliation(s)
- Sushil K Singh
- Cardiothoracic Surgery, Wakefield & Wellington Public Hospital, Private bag 7909, Florence Street, Newtown, Wellington South 6039, New Zealand
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20
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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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21
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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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22
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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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23
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Jeon DS, Miyamoto T, Fontana G, Friedman A, Siegel RJ. Pulmonary artery compression by a saphenous vein graft aneurysm and contrast echocardiography using an agitated mixture of ten percent air, ten percent blood, and ten percent saline. J Am Soc Echocardiogr 2002; 15:1529-32. [PMID: 12464923 DOI: 10.1067/mje.2002.125920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This case illustrates the use of intravenous injection of an agitated mixture of 10% air, 10% blood, and 80% saline during intraoperative transesophageal echocardiography in a patient with a saphenous vein graft aneurysm compressing the main pulmonary artery.
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Affiliation(s)
- Doo-Soo Jeon
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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24
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Harada T, Ida T, Koyanagi T, Kasahara K, Naganuma F, Hosoda S. Pseudoaneurysm of the saphenous vein graft related to artificial rubber pericardium--a case report. Angiology 2002; 53:741-3. [PMID: 12463631 DOI: 10.1177/000331970205300618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pseudoaneurysm is an unusual complication of coronary artery bypass grafting. Such aneurysms are caused by technical surgical failures, or inflammation of the sternum and mediastinum following sternotomy observed as an early or mid-term complication of cardiac surgery. This case was an 80-year-old man with a piece of artificial rubber pericardium used for complete closure of the pericardium. A large pseudoaneurysm developed in the body of the saphenous vein graft 15 years after surgery. The old rubber synthetic pericardium was severely degenerative, which induced inflammation and disrupted the saphenous vein graft.
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Affiliation(s)
- Tomohiro Harada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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25
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Abrishamchian AR, Gowdamarajan A, Michler RE. Saphenous vein graft aneurysm: potential for mistaken identity. J Card Surg 2002; 17:295-7. [PMID: 12546076 DOI: 10.1111/j.1540-8191.2001.tb01144.x] [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: 11/30/2022]
Abstract
We report the unusual presentation of a saphenous vein graft aneurysm in a 72-year-old man who had undergone coronary artery bypass surgery 15 years prior to admission. The patient presented with a large mass on the anterior wall of the right ventricle and chest discomfort; initially believed to be a cardiac tumor. The patient underwent reoperative coronary surgery with excision of the saphenous vein graft aneurysm, followed by an uneventful postoperative course. Aortocoronary saphenous vein graft aneurysms are rare and their presentation may be mistaken for pulmonary or chest wall lesions. Complications include rupture, and therefore require attentive diagnosis and surgical therapy.
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Affiliation(s)
- Ahmad R Abrishamchian
- Division of Cardiothoracic Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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26
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Botero M, Martin TD, Lobato EB. Pseudoaneurysm of a saphenous vein graft after coronary artery bypass graft surgery: differential diagnosis of a right atrial mass. J Cardiothorac Vasc Anesth 2001; 15:614-7. [PMID: 11688004 DOI: 10.1053/jcan.2001.26541] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Botero
- Department of Anesthesiology, University of Florida College of Medicine, and the Veterans Affairs Medical Center, Gainesville, FL, USA.
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27
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Bosmans JM, Claeys MJ, Dilling D, Vrints CJ. Unsuccessful long-term outcome after treatment of a vein graft false aneurysm with a polytetrafluoethylene-coated Jostent. Catheter Cardiovasc Interv 2000; 50:105-8. [PMID: 10816293 DOI: 10.1002/(sici)1522-726x(200005)50:1<105::aid-ccd23>3.0.co;2-2] [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: 11/06/2022]
Abstract
We describe a case in which a stented ulcerated plaque in an old vein graft ruptured to a huge false aneurysm. By the use of a PTFE-coated Jostent, the false aneurysm could be percutaneously closed. However, 6 months later, a new false aneurysm, probably due to focal perforation of the covered Jostent, developed.
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Affiliation(s)
- J M Bosmans
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.
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28
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Abstract
Late failure of saphenous vein aortocoronary bypass grafts is predominantly due to vein graft atherosclerotic disease. Rarely, saphenous vein aortocoronary bypass grafts undergo aneurysmal degeneration. We report a case of a giant true aneurysm of a saphenous vein aortocoronary bypass graft producing right heart failure from main pulmonary artery compression.
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Affiliation(s)
- M B Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Denver, USA
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29
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Abstract
After an aneurysmal saphenous vein graft was ligated and divided at reoperation, the proximal stump continued to enlarge, rather than occluding by thrombosis, producing an aortic pseudoaneurysm that compressed adjacent cardiac structures. Oversewing the aortosaphenous junction of ligated vein graft remnants will prevent this complication.
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Affiliation(s)
- B A Grishkin
- Fort Sanders Parkwest Hospital, Knoxville, Tennessee, USA
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30
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Abstract
Spontaneous rupture of coronary arteries as well as coronary perforation during percutaneous interventions are rare but potentially life-threatening incidents often resulting in emergency surgery. Frequency of acute perforation due to therapeutic catheterization varies according to the devices employed. With conventional balloon angioplasty it is estimated to be 0.1 to 0.2% whereas substantially higher rates of up to 3% have been reported with the use of so-called "new devices" (i.e. directional atherectomy, rotablation, excimer laser angioplasty or extractional atherectomy). Interventional strategies for nonsurgical treatment of acute coronary perforations during catheterization procedures have been developed. In recent times, availability of coronary stent-grafts allows for a percutaneous resolution of acute perforations while maintaining vessel patency. Whereas iatrogenic perforations in the catheterization laboratory may thus be treated immediately at the site of their occurrence, rupture of pre-existing but potentially unknown coronary pathology frequently is associated with a diagnostic interval, giving rise to serious clinical events (i.e. myocardial infarction, cardiac tamponade, malign arrhythmias or sudden death). It may be warranted to advocate prophylactic treatment of rupture-prone coronary conditions even on incidental diagnosis. This can either be performed by cardiothoracic surgery or, in suitable cases, by interventional therapy. Implantation of coronary stent-grafts could prove to become the therapy of choice due to its technical facility, safety and the short length of hospital stay associated with it. Before general recommendations can be made, however, as to the extension of indication for these novel coronary devices, further clinical studies encompassing long-term clinical and angiographic follow-up are needed.
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Affiliation(s)
- M Elsner
- Medizinische Klinik IV (Kardiologie/Nephrologie), Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt a. M.
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31
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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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32
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Mohara J, Konishi H, Kato M, Misawa Y, Kamisawa O, Fuse K. Saphenous vein graft pseudoaneurysm rupture after coronary artery bypass grafting. Ann Thorac Surg 1998; 65:831-2. [PMID: 9527226 DOI: 10.1016/s0003-4975(97)01435-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An elderly woman underwent coronary artery bypass grafting, which was followed 1 month later by pseudoaneurysmal rupture at the distal anastomosis of a saphenous vein graft. Emergency repair of the suture line dehiscence was made, and the postoperative course was uneventful. Pseudoaneurysm formation of a saphenous vein graft after coronary artery bypass grafting is a rare but potentially lethal complication requiring urgent operative intervention.
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Affiliation(s)
- J Mohara
- Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan
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33
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Ferreira AC, de Marchena E, Awaad MI, Schob A, Kessler KM. Saphenous vein graft aneurysm presenting as a large mediastinal mass compressing the right atrium. Am J Cardiol 1997; 79:706-7. [PMID: 9068545 DOI: 10.1016/s0002-9149(96)00852-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A patient with a large saphenous vein graft aneurysm is described. This case illustrates the role of magnetic resonance imaging and cardiac catheterization in patients with a mediastinal mass and history of coronary bypass surgery.
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Affiliation(s)
- A C Ferreira
- Department of Medicine, University of Miami School of Medicine, Florida 33136, USA
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