Management of Patients With Aortocoronary Saphenous Vein Graft Aneurysms

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

“…As for CAE, etiopathogenesis is not fully understood and several mechanisms have been proposed, including structural deterioration caused by graft atherosclerosis, technical issues related to surgical manipulation and adaptation of vein graft to higher arterial pressure with vessel wall weakening and dilatation. SVGAs usually progress over time, often reaching large diameter, and have a high incidence of life-threatening mechanical complications, such as compression of adjacent structures, fistulous communications, and rupture (56,57).…”

“…Percutaneous interventions are a valuable option for the treatment of SVGAs, especially in patients with high surgical risk and/or with preserved myocardial perfusion. These techniques have been increasingly used in recent years and include covered stent implantation, percutaneous closure with Amplatzer occluders and coil embolization with or without PCI of the native grafted vessel (57).…”

“…Similar results were reported in 1,565 patients from the international coronary artery aneurysm registry (CAAR), with no differences in terms of adverse cardiovascular events and mortality between patients treated with either surgical or percutaneous approach (6). According to these findings, surgical treatment of CAE should be considered as the first-line therapy in cases where PCI is deemed to be at high risk due to complex anatomical features, like for CAAs involving the LM, multiple or giant CAAs, and SVGAs with graft thrombosis, impaired myocardial perfusion and acute mechanical complications (11,57).…”

Rare vascular involvement in Behçet's disease: Coronary artery pseudoaneurysm

“…We suggest that neck and sac size should be carefully analyzed before making a decision. It is primarily the anatomical features, and not the pathological type of the coronary aneurysm, that determine what type of intervention would be appropriate 10 . We also strongly suggest that arterial grafts should be preferred if a surgical bypass is unavoidable, because BD more commonly affects veins, and saphenous vein graft pseudoaneurysms have been well‐documented in patients with both Behçet and non‐Behçet etiology 10–12 .…”

“…It is primarily the anatomical features, and not the pathological type of the coronary aneurysm, that determine what type of intervention would be appropriate 10 . We also strongly suggest that arterial grafts should be preferred if a surgical bypass is unavoidable, because BD more commonly affects veins, and saphenous vein graft pseudoaneurysms have been well‐documented in patients with both Behçet and non‐Behçet etiology 10–12 . It has been proposed that exposure of the vein to relatively higher arterial pressures and the subsequent chronic weakening of the vessel wall is the main etiological mechanism underlying development of true and false aneurysms of saphenous vein grafts 10 …”