Risk factors associated with saphenous vein graft aneurysm after coronary artery bypass graft

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.

Percutaneous closure of a coronary artery-to-vein graft anastomotic pseudoaneurysm presenting as acute coronary syndrome after recent coronary artery bypass grafting

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

Ruptured saphenous vein graft aneurysm

Ruptured saphenous vein graft (SVG) aneurysm is a rare source of significant morbidity and mortality. SVG is a common technique of coronary artery bypass grafting (CABG), but vein graft aneurysm and ruptured SVG aneurysm have not received the required attention as only few case reports exist. We present the case of a 50-year old man with ruptured vein graft aneurysm who had significant postoperative complications following surgery, and outline some preventive/management strategies.

Aneurysmal degeneration of a saphenous vein graft following the repair of a popliteal aneurysm: case report and literature review

True aneurysm formation in arterialized autologous veins is an unusual complication. A saccular aneurysmal degeneration of 53 mm (maximal diameter) of a saphenous vein graft inserted for repair of a popliteal aneurysm, four years after implantation, is reported. The patient (with prior history of abdominal aortic aneurysm) had been initially treated through a posterior approach. A new saphenous vein bypass grafting (medial approach) was performed. Histological examination revealed myointimal fibrosis, medial degeneration and inflammation. In spite of the widespread use of the autologous saphenous vein as an arterial substitute, this complication is extremely rare and its etiology remains unclear. Atherosclerosis is considered to be the main cause of aneurysm formation in vein grafts, but current data suggest that additional etiopathogenic factors should be further investigated. We note the rarity of this finding and review the literature for true aneurysm formation within vein grafts used for bypass procedures.

Cytocompatibility of electrospun nanofiber tubular scaffolds for small diameter tissue engineering blood vessels

A tubular scaffold was fabricated by using electrospun polymer solution blends of pNSR32 (recombinant spider silk protein), PCL (polycaprolactone) and Gt (gelatin). The physicochemical properties and cytocompatibility of these scaffolds were investigated. Afterwards, the pNSR32/PCL/Gt tubular scaffold (inner diameter=3mm) showed high porosity of 86.2 ± 2.9%, pore size of 2423 ± 979nm and average fibre diameter of 166 ± 85nm. Water uptake and contact angle of the scaffolds reached 112.0 ± 4.4% and 45.7 ± 13.7°, respectively. SDRAECs (Sprague Dawley Rat Aortic Endothelial Cells) grew and proliferated well and phenotype could be maintained on the composite scaffolds after they had been cultured on the composite scaffolds for 7 days. Compared with pure PCL scaffolds a greater density of viable cells was seen on the composites, especially the pNSR32/PCL/Gt scaffolds.