Severe Dilatation of Saphenous Vein Grafts: A Late Complication of Coronary Surgery in Which the Diagnosis Is Suggested by Chest X-Ray

Abstract

Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm. We report 1 case and review 107 cases published since 1975. Severe SVG dilatations are large (6 ± 3 cm), occur remote from surgery (12 ± 4 years) and are life threatening, with 15.7% in-hospital mortality. Symptoms are nonspecific and the abnormality is initially observed by chest X-ray in 57% of cases. The chest X-ray abnormalities have a distinctive appearance that may suggest both diagnosis and which SVG is involved. Diagnosis is made clinically by imaging, i.e. computed tomography, echocardiography, magnetic resonance and/or surgical observation (66 cases), or most accurately by tissue evaluation by the pathologist (42 cases). Aneurysm is more common than pseudoaneurysm by a 6:1 ratio.

Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms

“…64 Similarly, echocardiography has limitations in that not all SVGAs can be properly imaged, depending on their location, with several reports describing their misdiagnoses as intracardiac masses with the technique. [65][66][67] Therefore, given the potential limitations of coronary angiography and echocardiography, a crosssectional modality such as CT or magnetic resonance imaging should be used in the initial assessment to definitively establish the presence of an SVGA and to assess for mechanical complications. Furthermore, with the increasing proficiency of coronary CT angiography, information on native and graft vessel anatomy may be derived in some instances without catheterization (Figure 2A and 2B).…”

Pulmonary outflow stenosis due to saphenous vein graft aneurysm: a rare case report and review of literature

“…Due to such pathophysiology, pseudoaneuryms are commonly seen as an acute finding whereas true aneuryms caused by atherosclerosis, are more subclinical and chronic in nature. It is also important to note that true aneurysms are more common than pseudoaneurysms by a ratio of 6:1 [13]. Because the differentiation between a pseudoaneurysm and true aneurysm is pathologically determined and not always delineated, the term "aneurysm" will be used in the remainder of this report.…”

“…They further suggested that SVGAs radiographically visualized in the right sternal border mainly represent SVGAs bypassing the right coronary artery and that SVGAs seen in the left upper sternal border seem to typically bypass the left anterior descending artery. Ones seen in the left lower sternal border were found to be bypassing the LAD and left circumflex artery or both [13].…”

A case of giant saphenous vein graft aneurysm successfully treated with catheter intervention

“…Although SVG aneurysms are often incidentally identified on any type of imaging modality, there are some reports about cases of rupture 4, fistula formation with neighboring anatomy 5, and hemodynamic compromise resulting from compression of adjacent cardiac and vascular structures 6. Moreover, in‐hospital mortality associated with giant SVG aneurysms was reported to be 15.7% 7.…”