Aneurysmal saphenous vein graft presenting as an anterior mediastinal mass

Hughes, Michael; Rice, Thomas W.; Simpfendorfer, Conrad

doi:10.1002/ccd.1810240409

Cited by 21 publications

(7 citation statements)

References 13 publications

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“…Our literature review identified 107 patients [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95]. The demographic, clinical and pathological features are summarized in ...…”

Section: Resultsmentioning

confidence: 99%

Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray

et al. 2005

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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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Section: Resultsmentioning

confidence: 99%

Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray

et al. 2005

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“…The average time of development of this complication is approximately 10 to 20 years postoperatively, and the etiology is usually due to ongoing atherosclerosis [5,12]. Aneurysms developing in the first few months after surgery have been attributed to surgical trauma particularly affecting branch points [13,14].…”

Section: Discussionmentioning

confidence: 98%

“…The smooth muscle layer in these areas are formed in a longitudinal rather than a circumferential fashion, contributing to weak spots prone to degeneration secondary to the increased stress of the arterial pressure [2]. Other contributing factors include infection, vein graft necrosis, and trauma [2,5,14].…”

Section: Discussionmentioning

confidence: 99%

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Superior vena cava syndrome secondary to saphenous venous graft aneurysm with right atrial fistula

Fares

Sharifi

Steele

et al. 2003

Cathet Cardio Intervent

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“…Some of these aneurysms are incidentally found on chest radiography as a mediastinal mass [4,5], but more often they present as unstable angina or acute myocardial infarction due to vein graft thrombosis [6]. A very unusual complication of these aneurysms is the development of a fistula between the aneurysmatic SVG and one of the chambers of the heart.…”

Section: Introductionmentioning

confidence: 98%

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: Case report and review of the literature

Gruberg

Satler

Pfister

et al. 1999

Cathet. Cardiovasc. Intervent.

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The sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) are the cornerstones of cardiovascular adaptation. The simultaneous presence of disorders involving both is not uncommon, especially in patients with coronary artery disease undergoing coronary artery bypass surgery (CABG). This is the case of a patient with both hyporeninemic hypoaldosteronism and autonomic dysfunction. This article describes his clinical course before and after CABG surgery, along with a literature review of those interrelated entities. Our patient is a 63-year-old male with a history of hypertension and hyperlipidemia presenting for CABG for triple vessel disease. On the day of admission, the patient had sudden unprovoked loss of consciousness along with hypotension and bradycardia. He reported having had similar episodes in the past at times of emotional stress. After stabilization, the patient underwent CABG surgery the next day and it was uneventful. Four hours later, he developed another episode of hypotension with bradycardia which resolved upon administration of fluids. On postoperative day 2, while removing the jugular line, he had loss of consciousness with 5 seconds pause recorded on his bedside monitor. A carotid massage confirmed carotid sinus hypersensitivity, which necessitated the insertion of a pacemaker. However, patient continued to have similar episodes despite a functioning device. Workup revealed hyporeninemic hypoaldosteronism with an undetectable aldosterone level, although patient was not diabetic, had normal cortisol level, and had no other risk factors for those findings. Patient was started on fludrocortisone 0.1 mg daily; his hemodynamics improved markedly, and his symptoms resolved permanently. Our patient has hyporeninemic hypoaldosteronism caused most likely by his autonomic dysfunction, rather than having of two separate entities. A review of the literature showed that primary autonomic insufficiency with reduced circulating norepinephrine levels prevent renin activation and subsequently aldosterone release, leading to hyporeninemic hypoaldosteronism. Coronary artery disease is a known cause of autonomic dysfunction and CABG surgery unmasks this entity, which explains the exacerbation of our patient's symptoms during this phase.

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Aneurysmal saphenous vein graft presenting as an anterior mediastinal mass

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.

Cited by 21 publications

References 13 publications

Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray

Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray

Superior vena cava syndrome secondary to saphenous venous graft aneurysm with right atrial fistula

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: Case report and review of the literature

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