Large aneurysm in saphenous vein coronary artery graft with fistula: case report and review

Abstract

Aneurysms developing in a saphenous vein graft (SVG) after coronary artery bypass grafting (CABG) are an unusual complication and fistulae forming between an SVG aneurysm and a cardiac chamber are even rarer. A 71-year-old man had undergone a triple CABG with the left internal thoracic artery and double SVGs. Twenty years later, he was admitted with repeated congestive heart failure. A large true aneurysm (99 × 60 mm) developed in the mid portion of a saphenous vein graft to the right coronary artery together with a fistula with a diameter of 8 mm in the right atrium. The aneurysm was surgically resected and the fistula was closed.

Percutaneous treatment of a massive saphenous vein graft aneurysm

“…True aneurysms which are graft weaknesses at valve or branch sites from missed varices, damage during the original surgical procedure or later with atherosclerotic degeneration while pseudo‐aneurysms occur at sites of aortotomy, ligated tributaries or at an anastomosis and are often associated with infection . A SVG aneurysm can lead to further complications such as ischaemia, mass effect on the superior vena cava and cardiac structures, rupture, tamponade, hemothorax, and fistula formation . However, half of all patients are asymptomatic upon presentation and usually identified incidentally by a radiological test …”