Percutaneous Treatment of a Large Vein Graft Aneurysm With Covered and Conventional Stents

Abstract

A 75-year-old man presented with typical angina 13 years after coronary artery bypass grafting. Angiography demonstrated a patent internal mammary graft to the left anterior descending artery and vein graft to the obtuse marginal branch of the left circumflex artery. The large-caliber right coronary graft had a large false aneurysm in its midportion, at the site of a severe stenosis. The aneurysm appeared to compress the graft distally. Three 17-mm polytetrafluoroethylene (PTFE)-covered stents (Abbott Vascular Devices) were each hand-crimped on a 5ϫ20-mm balloon and deployed with overlap across the neck of the aneurysm. Two baremetal stents (5ϫ28 mm and 5ϫ32 mm) were also deployed with overlap into the covered stents, to splint the PTFE stents within the aneurysm. A minor endoleak was present at the end of the procedure. Repeat angiography 6 weeks later showed complete exclusion of the false aneurysm and a widely patent stented segment (Figure).Vein graft false aneurysms are uncommon but may develop late after coronary artery bypass grafting surgery; they are usually atherosclerotic in origin. Traditionally, they have been treated by surgical excision or percutaneous coil embolization. This large false aneurysm was treated with multiple balloon-expanded PTFE-covered stents. A covered selfexpanding stent might also have been used to exclude the false aneurysm. DisclosuresNone.

Circulatory Failure and Lactic Acidosis Associated with Giant Saphenous Vein Graft Aneurysm

“…Embolization or stenting of the aneurysms is another treatment option [10,11]. Unfortunately, our patient deteriorated rapidly to provide the surgical treatment he needed.…”

Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations

“…With the development of coronary and peripheral vascular percutaneous methods to deliver covered stents, interventions on saphenous vein graft aneurysms are feasible, even in dilated, degenerative vein grafts. Although comparative studies are not possible, the observed low mortality rate for percutaneous options is encouraging in light of the high risk of repeat sternotomy . Given the potential role of percutaneous management of SVGA, consideration of methods to deliver covered stents should be considered before exposing the patient to this risk of repeat sternotomy.…”

“…Although comparative studies are not possible, the observed low mortality rate for percutaneous options is encouraging in light of the high risk of repeat sternotomy. 26 Given the potential role of percutaneous…”

Repeat Percutaneous Treatment of a Large Vein Graft Aneurysm with Covered Stents

“…His left internal mammary to the left anterior descending, and the vein graft to the circumflex arteries were patent. We previously reported successful treatment of this with a combination of three 17-mm polytetrafluoroethylene (PTFE) balloon expandable covered stents, and two bare metal stents, to enable "bridging" from entry to exit of the aneurysm [1]. Follow up angiography had demonstrated complete exclusion of the false aneurysm (Fig.…”