Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts

Breton, Hervé; Pavin, Dominique; Langanay, Thierry; Roland, Y; Leclercq, Claire; Beliard, J M; Bédossa, Marc; Rioux, C; Pony, J C

doi:10.1136/hrt.79.5.505

Cited by 92 publications

(84 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Aneurysms or pseudoaneurysms of vein grafts that develop after bypass surgery are very unusual. Despite the large number of patients that have undergone this type of surgery, there are only 50 reported cases in the literature since the introduction of bypass surgery in 1969 [7].…”

Section: Discussionmentioning

confidence: 99%

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.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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.

View full text Add to dashboard Cite

show abstract

“…True aneurysms of SVG are atherosclerotic in nature and appear as a late postoperative complication more than five years after CABG [2]. In this case, occurence of the giant aneurysm may have been related to the previous PTCA.…”

mentioning

confidence: 79%

“…The complications of an SVG aneurysm include thrombosis, embolism, and rupture. Most SVG aneurysms have been treated with either exclusion or resection of the aneurysms and, if necessary, with revascularization [2,4,7].…”

mentioning

confidence: 99%

Saphenous Vein Graft Aneurysm Late After Coronary Artery Bypass Grafting

Kobayakawa¹,

Tanabe²,

Yamaguchi³

et al. 2006

J Echocardiogr

View full text Add to dashboard Cite

A 77-year-old woman was admitted to our hospital for evaluation of ischemic heart disease. She underwent two coronary artery bypass graft (CABG) at ages 60 and 67. With the first CABG in 1985, saphenous vein grafts (SVGs) were anastomosed to the left anterior descending (LAD), the obtuse marginal, and the posterior descending arteries (PD). She was asymptomatic until 1992 when she underwent coronary angiography for recurrent chest pain. The angiographic study demonstrated a tight stenosis of the SVG anastomosed to the LAD. The other two SVGs anastomosed to the obtuse marginal and the PD were occluded. She underwent subsequent CABG with three new bypass grafts a left internal thoracic artery graft (LITA) to LAD, a SVG to the obtuse marginal artery, and the gastroepiploic artery (GEA) to the PD. However postoperative angiography showed that the LITA and GEA were occluded. She therefore underwent percutaneous transluminal coronary angioplasty (PTCA) to the first SVG graft anastomosed to the LAD. The angiographic study status post PTCA demonstrated an intact SVG graft. The patient did well and had no chest pain for almost 10 years; she had been clinically man- Saphenous Vein Graft Aneurysm Late After Coronary Artery

show abstract

“…46 In venous grafts that are not old or degenerated, proposed mechanisms for pseudoaneurysm formation include weakness in the veins at branch locations or valves, ac cidental damage to the graft during the initial surgery, infection, and wall disruption related to stent placement in the SVG after CABG. 5 The mechanism for pseudo aneurysm formation early in the postoperative course (such as in our patient) most likely pertains to technical factors of the surgical procedure at the anastomotic site.…”

Section: Fig 4 Eight Weeks After the First Embolization Attempt A Cmentioning

confidence: 99%

Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

Maybrook¹,

Sharma²,

Gupta³

et al. 2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

Pseudoaneurysm formation has been reported in degenerated coronaryP seudoaneurysms of degenerated saphenous vein grafts (SVGs) can form after coronary artery bypass grafting (CABG).1 Pseudoaneurysm formation at the distal anastomotic site after CABG is very rare, and the clinical presentation and treatment of this phenomenon have not been well described. We present the case of a recent CABG patient whose pseudoaneurysm at the coronary artery-SVG anastomosis was treated by means of percutaneous coil embolization. In addition, we discuss other management options. Case ReportIn December 2012, a 63yearold man presented at another hospital with syncope and a nonSTsegmentelevation myocardial infarction (NSTEMI), a peak troponin I level of 11.4 ng/mL, and associated new Twave inversions in the inferior electro cardiographic leads. He had undergone 4vessel, onpump CABG 4 weeks earlier: a graft of the left internal mammary artery to the left anterior descending coronary artery, a saphenous vein graft to the right posterior descending artery, and a saphenous vein Y graft to a superior branch of the ramus intermedius (RI) and the first diagonal branch. A quantitative coronary angiogram showed a 1.7 × 1.5cm pseudoaneurysm that appeared to arise from the SVG-RI anastomotic site (Fig. 1A). Even though the pseudoaneurysm filled after angiographic contrastmedium injection from both the left main coronary artery (LMCA) and the SVG, the filling was substantially more pronounced when injections were made from the SVG (Fig. 1B). The other bypass grafts were patent, and no new obstructive native coronary artery lesions were apparent. It was presumed that the patient's NSTEMI was secondary to the pseudo aneurysm-most likely from distal embolization of intraluminal thrombus from the pseudoaneurysm, even though no distal cutoff or other angiographic evidence of embolization was noted. Another possible mechanism by which the pseudoaneurysm could cause acute coronary syndrome (ACS) was mass effect; however, no compres sion of the adjacent vessels was seen. The patient was referred to our center for further Case Reports

show abstract

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts

Cited by 92 publications

References 9 publications

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

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

Saphenous Vein Graft Aneurysm Late After Coronary Artery Bypass Grafting

Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

Contact Info

Product

Resources

About