A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presenting as a left lung mass

Abstract

Aneurysm of a saphenous vein graft (SVG) is a rare but fatal complication of coronary artery bypass graft (CABG) surgery. The development of SVG aneurysms appears usually about 10-20 years after the operation at an estimated rate of <1%. A 68-year-old male was referred to the emergency department after frequent episodes of dyspnea, chest pain and hemoptysis. He previously had CABG surgery one year before. The physical examination was normal. Chest radiogram showed a left pulmonary midzone mass. CT-angiogram demonstrated a large aortic pseudoaneurysm (6.36 x 6.06 cm) in the middle part of the ascending aorta. After sternotomy, the ascending aorta above sinotubular junction near the origin of brachiocephalic artery was resected and replaced with a tube graft. The patient was transferred to ICU with stable hemodynamic status. SVG aneurysm should be considered while encountering mediastinal mass or undiagnosed cardiopulmonary symptoms in patients with a previous history of CABG because of its rarity and overlap of symptoms with other thoracic, pulmonary, and cardiac diseases. Surgery seems to be the treatment of choice to reduce the risk of rupture and embolism.

Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms

“…Some authors have also suggested that the abrupt change in wall stress when the graft is subjected to the high pressure and pulsatile flow of an arterial system may play a role in aneurysm formation. 20 However, the delayed presentation and low incidence of these lesions suggest that arterial pressures alone unlikely contribute significantly to aneurysm formation. Rather, atherosclerotic changes, graft endothelial dysfunction, and changes in medial smooth muscle cell orientation in the vicinity of valve sites likely play more pivotal roles in late aneurysm development.…”

Just Another Acute Chest Pain? Case of Contained Rupture of a Saphenous Venous Graft Pseudo-Aneurysm Mimicking Acute Coronary Syndrome

“…A majority of the reported symptomatic cases were male, presenting between 11 and 20 years after CABG [7]. Other extreme presentations are present in literature, with pseudo-aneurysms presenting as superior vena cava syndrome secondary to direct compression [10] or even large lung masses [11].…”

Covered stent implantation for giant saphenous vein graft pseudoaneurysms

“…Patients can present with chest pain, dyspnea and associated compression from the mediastinal mass [2]. Treatments such as surgical repair and percutaneous coronary intervention (PCI) are not well defined.…”

“…A number of causative factors have been hypothesized in the pathogenesis of this disorder [2] including inherent weakness in the vessel wall due to a lack of…”

“…A number of causative factors have been hypothesized in the pathogenesis of this disorder [2] including inherent weakness in the vessel wall due to a lack of International Journal of Cardiology 156 (2012) e65-e67 circumferential muscle at venous valves, damage during PCI, and simply atherosclerotic degeneration of the vein. In this case, chronically high forces exerted by the Wallstent may have favored aneurysm formation.…”