Huge saphenous vein graft aneurysm presenting as non-ST elevation myocardial infarction and compressing the heart

Abstract

Coronary artery bypass grafting (CABG) surgery maintains an important role in the treatment of coronary artery disease. The huge saphenous vein graft aneurysm (HSVGA) is rare and occurs as a late complication after CABG. Here, we reported a case of HSVGA presenting as non-ST elevation myocardial infarction.

Non-ST-Segment Myocardial Infarction Resulting From Thrombotic Saphenous Vein Graft Aneurysm

“…Our case presents a thrombosed SVGA causing NSTEMI through suspected distal embolization. There are many case reports of MI resulting from mechanical compression of the myocardium [ 9 , 10 ], but none report distal thrombus embolization from SVGA. Coronary embolization (CE) is an established cause of 4-7% of MI [ 11 , 12 ], and was first described by Virchow in 1856 [ 11 ].…”

Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations

“…This most likely underestimates the true number as saphenous venous aneurysms often remain clinically silent with no guidelines recommending screening for their development. Although SVGA are often detected incidentally on imaging, cases of fistula formation, rupture, acute chest discomfort, hemoptysis, and hemodynamic compromise resulting from compression of adjacent vascular and cardiac structures have been reported …”

“…Although SVGA are often detected incidentally on imaging, cases of fistula formation, rupture, acute chest discomfort, hemoptysis, and hemodynamic compromise resulting from compression of adjacent vascular and cardiac structures have been reported. [3][4][5][6][7][8][9][10] Saphenous vein graft aneurysm will typically arise remotely from the initial CABG, being identified an average of 13 years after the surgery. In fact, in only 4% of patients had SVGA diagnosed within the first year after CABG, compared to 68% noted more than 10 years after surgery.…”