Thrombosed aneurysm of saphenous vein coronary artery bypass grafting

Abstract

We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential.Keywords: aneurysm, bypass, coronary, saphenous, myocardium. case reportMale patient, 76 years old, underwent complementary investigation through imaging examinations due to complaints of retrosternal chest pain and mild dyspnea several months ago. The patient reported hospitalization and clinical treatment of acute myocardial infarction one month before. The patient had hypertension, dyslipidemia, was a former smoker and had a history of two other acute myocardial infarctions prior to 2010. The patient's history included saphenous vein coronary artery bypass grafting (SVCABG) for about 30 years, two percutaneous transluminal coronary angioplasty procedures, one with stenting to clear the SVCABG, and surgical repair of abdominal aortic aneurysm with endoprosthesis for approximately 4 years. Reports of catheterizations prior to 2015 described new SVCABG occlusion.A chest radiograph showed only a metallic sternal suture and a small stent near the cardiac silhouette ( Figure 1A and B).The echocardiogram showed a hypoechoic, elongated oval image, adjacent to the right cardiac chambers, causing a slight extrinsic compression on diastole ( Figure 2A and B), apparently without flow according to color Doppler investigation. The diagnostic possibility of pericardial cyst was raised.Computed tomography of the thorax showed a large, oval and elongated hypoattenuating (approximately 45 HU) mediastinal mass with lobulated contours, located in close contact with the right heart chambers, presenting peripheral parietal calcifications with a maximum caliper of 4.9 cm and measuring approximately 10.0 cm in length ( Figure 3A-C), not enhanced after the injection of intravenous contrast medium ( Figure 3D-F). The mass could be seen from the emergence of the ascending aorta, with the small stent evident in its interior, extending even to the lower cardiac wall. Such findings were compatible with thrombosed SVCABG aneurysm...

Hepatic artery reconstruction using interposition of autologous saphenous vein conduit for living donor liver transplantation: a case report

“…The GSV is a small-sized thick-walled vein, thus it has been frequently used as an arterial substitute for CABG for a long period [ 6 ]. Very long patency of patent CABG with a GSV graft has been reported [ 7 ], but there was a potential risk of aneurysm and pseudoaneurysm after the CABG using GSV grafts [ 8 , 9 ]. The present case underwent retransplantation due to chronic rejection 8 years after LDLT, in which the GSV conduit was patent without any vascular complications throughout the 8-year period.…”