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

Abstract

Rupture of a saphenous vein graft (SVG) pseudo-aneurysm presenting as a non-ST elevation myocardial infarction is a rarely reported, but serious complication of prior coronary artery bypass graft surgery. We present a case of a 76-year-old man who presented with severe chest pain and elevated cardiac biomarkers, and was found to have a contained pseudo-aneurysm rupture at the site of anastomosis of a 15-year SVG with the ascending aorta requiring surgical repair. We also review presenting symptoms, the current literature and treatment approaches for SVG pseudo-aneurysm.

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

“…Patients may present with chest pain, heart failure, or mass effect due to the compression of cardiac chambers and mediastinal structures. 4,5 Pseudoaneurysm rupture has also been described in case reports. 6 Cases presenting early after surgery are believed to be due to poor surgical technique, infection, and inflammation whereas the etiology in late presenting cases is believed to be delayed suture dehiscence.…”

“…There is wide variation in clinical presentation. Patients may present with chest pain, heart failure, or mass effect due to the compression of cardiac chambers and mediastinal structures . Pseudoaneurysm rupture has also been described in case reports .…”