Atherosclerotic Aneurysm Formation in a Lower Extremity Saphenous Vein Graft

Abstract

Saphenous vein is the most widely used conduit for arterial bypass procedures and aneurysms of the vein graft are rare. We report a true aneurysm of a reversed femoropopliteal saphenous vein graft implanted nine years earlier. Duplex ultrasonography identified an aneurysm of the saphenous vein graft and arteriography confirmed this finding. A consideration for endovascular coiling of the aneurysm was entertained, but no proximal "neck" on the aneurysm was present. The patient, therefore, underwent an uneventful resection of the aneurysm with end-to-end anastomosis. Histopathologic examination of the aneurysm demonstrated atherosclerotic degeneration with endothelial disruption, medial necrosis, and fibrous proliferation. The cause of a saphenous vein graft aneurysm is rare and unknown. The management of vein graft aneurysms, however, should be subject to the same criteria that apply to other aneurysms because once vein graft dilation occurs, it is followed by a rapid increase in size, which may lead to possible rupture.

Aneurysmal degeneration of vein conduit used for vascular reconstruction—Case report and literature review

“…Once diagnosed, surgical repair should be performed as soon as possible as graft dilatation tends to occur overtime and is typically followed by a rapid increase in size over a short period of time [7] . The type of surgical intervention depends on the extent of aneurysmal dilatation as diffuse disease dictates complete graft replacement whereas aneurysm resection with preservation of graft and autologous or prosthetic interposition may be achieved in isolated aneurysms [16] . Endovascular placement of expandable polytetraflurorethylene-covered nitinol endoprosthesis has been used as an alternative to open surgery in rare cases, however the long-term patency and efficiency are unknown to date [17] .…”

Aneurisma de enxerto de veia safena após reconstrução arterial: relato de caso

“…Aneurysms of saphenous vein grafts are rare occurrences 1,2,6,9 . The literature on the subject is comprised only of case reports, so data on its etiology and clinical evolution are inconsistent.…”

“…However, there are reports on such occurrence with aortorenal 7 , iliac-femoral 8 , carotid-carotid 9 , and infrainguinal bypass grafts 1,2 . Most patients are asymptomatic, and may present a pulsatile mass when the graft is in a superficial position.…”

“…Degeneration and aneurysm formation related to this graft are extremely rare 1 . The cause of venous graft degeneration remains unknown 1,2 , and some authors mistake it for atherosclerosis 3 or a process of blood vessel dilation 4 .…”

“…Degeneration and aneurysm formation related to this graft are extremely rare 1 . The cause of venous graft degeneration remains unknown 1,2 , and some authors mistake it for atherosclerosis 3 or a process of blood vessel dilation 4 . Histopathological investigation has shown proliferative and fibrous lesions in the intima that lead to a significant weakening of the vein wall, favoring graft aneurysm formation 5 .…”