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Outcomes of patients who undergo elective covered stent treatment for coronary artery aneurysms. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:91-96. [PMID: 34034989 DOI: 10.1016/j.carrev.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coronary artery aneurysms (CAA) are reported in up to 5% of patients undergoing coronary angiography. Treatment of CAAs with covered stents has been reported in several case reports, however there is limited evidence available on the effectiveness and safety of this interventional practice. PURPOSE To evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents. METHODS We conducted a systematic review of published case reports and case series of patients presenting with CAA that have been treated with covered stents in a non-emergency setting. RESULTS A total of 63 case reports and 3 case series were included in the final analysis comprising data from 81 patients. The treated CAA was situated in a native coronary artery in 92.6%, and in a saphenous vein graft in 7.4%. Procedural success was achieved in 95.1%. The types of stents used were mainly polytetrafluoroethylene (75.3%) and Papyrus (11.1%). In 11.0% of cases additional abluminal drug eluting stents (DES) and in 6.8% additional adluminal DES were implanted. After a mean follow up of 13.4 months overall major adverse cardiovascular events (MACE), mortality, myocardial infarction, stroke, stent thrombosis and target lesion revascularization were reported in 26.2, 0.0, 7.6, 0.0, 4.6 and 18.5% of cases, respectively. CONCLUSIONS The use of covered stents for elective treatment of CAA appears to be effective and reasonably safe. Nevertheless, it is associated with higher MACE rate, driven mainly by higher target lesion revascularization. Further studies, particularly in form of randomized trials and controlled registries are warranted to identify patients who might profit the most from this procedure.
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Vinciguerra M, Spadaccio C, Tennyson C, Karuppannan M, Bose A, Greco E, Rose D. Management of Patients With Aortocoronary Saphenous Vein Graft Aneurysms: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2236-2253. [PMID: 33926660 DOI: 10.1016/j.jacc.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
Saphenous vein graft aneurysms (SVGAs) following coronary artery bypass grafting (CABG) surgery were first described in 1975. Although rare, in the absence of a prompt diagnosis, SVGAs can be responsible for serious complications and adverse outcomes. The clinical presentation of SVGAs described in the literature can vary from an asymptomatic patient with an incidental radiological finding to a profoundly shocked patient with life-threatening hemorrhage secondary to SVGA rupture. Improvements in diagnostic tools within the last decade, such as multislice computed tomographic scanning, has enabled early detection of SVGAs, and therefore, an expansion of the current management options. In this review, the current data and knowledge about clinical presentation, diagnosis, natural history, and treatment of SVGAs are updated, with a specific emphasis on the evolution of management strategies of this rare complication over the last 45 years. Finally, a clinical algorithm to guide decision-making and management is proposed.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Charlene Tennyson
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Mukesh Karuppannan
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Amal Bose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - David Rose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.
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Khan A, Brienesse S, Boyle A, Collins N. Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations. Catheter Cardiovasc Interv 2019; 93:927-932. [DOI: 10.1002/ccd.28128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/28/2018] [Accepted: 01/20/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Arshad Khan
- Cardiovascular Department, John Hunter Hospital Newcastle Australia
- School of Medicine and Public Health, The University of Newcastle Newcastle Australia
- Cardiovascular Research Program, Hunter Medical Research Institute Newcastle Australia
| | - Stephen Brienesse
- Cardiovascular Department, John Hunter Hospital Newcastle Australia
- School of Medicine and Public Health, The University of Newcastle Newcastle Australia
| | - Andrew Boyle
- Cardiovascular Department, John Hunter Hospital Newcastle Australia
- School of Medicine and Public Health, The University of Newcastle Newcastle Australia
- Cardiovascular Research Program, Hunter Medical Research Institute Newcastle Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital Newcastle Australia
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Walters D, Patel M, Penny W. Saphenous Vein Graft Aneurysm: A Case-Based Review of Percutaneous Management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1190-1195. [PMID: 30850317 DOI: 10.1016/j.carrev.2019.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
Abstract
SVG aneurysms are relatively rare clinical entities most often encountered discovered as an incidental finding in patients with prior CABG surgery. There is a substantial risk of complications including rupture and death, thus surgical or percutaneous management may be considered in particular in symptomatic patients. Here, three cases are presented highlighting various percutaneous management options and considerations, including covered stent placement, coil occlusion, and a combined approach with the use of a peripheral covered stent. Intervention within this patient population lacks large population long-term outcomes and as such should be performed carefully by experienced operators, often the guidance of a Heart Team based approach.
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Affiliation(s)
- Daniel Walters
- University of California, San Diego, United States of America.
| | - Mitul Patel
- University of California, San Diego, United States of America.
| | - William Penny
- University of California, San Diego, United States of America.
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Haghighat A, Burke TH, Speirs JWD, Glanz AE. Case report: Unusual presentation of haemopericardium with haemodynamic instability secondary to a coronary graft pseudoaneurysm treated by an endovascular approach. EUROPEAN HEART JOURNAL: CASE REPORTS 2018; 2:yty147. [PMID: 31020222 PMCID: PMC6426035 DOI: 10.1093/ehjcr/yty147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/12/2018] [Indexed: 11/14/2022]
Abstract
Background Case summary Discussion
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Affiliation(s)
- Arvin Haghighat
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada,Corresponding author. Tel: 1-519 566-4687, Fax 1-519 979-5611,
| | | | - John W D Speirs
- Division of Interventional Radiology, Department of Radiology, Windsor Regional Hospital, Windsor, ON, Canada
| | - Anthony E Glanz
- Division of Cardiology, Department of Medicine, Windsor Regional Hospital, Windsor, ON, Canada
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Boi A, Sanna F, Rossi A, Loi B. Exclusion of a giant saphenous vein graft pseudo-aneurysm with a "double-layer bridging" technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:8-12. [PMID: 30007870 DOI: 10.1016/j.carrev.2018.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022]
Abstract
We report the case of a 72-year-old man admitted to our hospital for chest pain. He had undergone coronary artery bypass graft surgery 23 years before. Contrast-enhanced computer tomography revealed a severe double-lobed dilatation of the saphenous vein graft for the obtuse marginal branch. Coronary angiography did not opacify completely the saphenous vein graft for the huge turbulence in the dilatation. Severe saphenous vein graft dilatation have a significant mortality and it has been generally treated by surgical repair, such as resection with or without bypass of the affected territory. We described an interventional technique, named "double-layer bridging" that combines metallic DES and covered stent used in a double layer. This percutaneous technique, relatively simple and virtually usable for any type of severe dilatation independently of length, can be a reasonable and safe option to exclude giant aneurysm and maintaining distal flow.
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Affiliation(s)
- Alberto Boi
- Azienda Ospedaliera Brotzu, Interventional Cardiology, Cagliari, Sardegna, Italy.
| | - Francesco Sanna
- Azienda Ospedaliera Brotzu, Interventional Cardiology, Cagliari, Sardegna, Italy
| | - Angelica Rossi
- Azienda Ospedaliera Brotzu, Interventional Cardiology, Cagliari, Sardegna, Italy
| | - Bruno Loi
- Azienda Ospedaliera Brotzu, Interventional Cardiology, Cagliari, Sardegna, Italy
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Hu H, Chen X, Wu Z, Zhao J, Huang B, Ma Y, Yuan D, Yang Y, Xiong F. Aneurysmal Degeneration of an Aortorenal Bypass for Takayasu Renal Artery Stenosis: A Novel Endovascular Intervention. Ann Vasc Surg 2018; 49:316.e1-316.e4. [DOI: 10.1016/j.avsg.2017.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/03/2017] [Accepted: 12/13/2017] [Indexed: 10/17/2022]
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Shammas NW, Chammas MZ, Robken J, Geiss D. Percutaneous Closure of the Aorto-Ostial Origin of a Coronary Artery Saphenous Bypass Graft with a Large Pseudoaneurysm Using the AMPLATZER Muscular Ventricular Septal Defect Occluder. Int J Angiol 2016; 26:196-200. [PMID: 28804238 DOI: 10.1055/s-0036-1593446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We report the case of a 76-year-old male patient with a history of coronary artery bypass graft surgery presented with a large pseudoaneurysm emerging from a previously occluded saphenous bypass graft (SVG). A largely contained hematoma is seen in the mediastinum on computed tomography angiography (CTA) of the chest. Flow was seen from the ascending aorta into the pseudoaneurysm through the aorto-ostial opening of the bypass graft. Closure of the aorto-ostial origin of the graft was performed using the AMPLATZER muscular ventricular septal defect (VSD) occluder (St Jude's Medical, St. Paul, MN) with immediate interruption of flow into the graft and the pseudoaneurysm. A repeat CTA of the ascending aorta at 6 months postprocedure continued to confirm an optimal positioning of the occluder with no flow into the pseudoaneurysm. This case offers an endovascular alternative to close the aorto-ostial opening of a saphenous bypass graft in the setting of a rare but potentially life-threatening SVG pseudoaneurysm.
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Affiliation(s)
| | | | - Jon Robken
- Cardiovascular Medicine, PC, Davenport, IA
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Takayama T, Akutsu N, Hiro T, Oya T, Fukamachi D, Haruta H, Iida K, Kougo T, Mineki T, Nishida T, Murata N, Oshima T, Hata H, Shiono M, Hirayama A. A case of giant saphenous vein graft aneurysm followed serially after coronary artery bypass surgery. Open Med (Wars) 2016; 11:155-157. [PMID: 28352785 PMCID: PMC5329817 DOI: 10.1515/med-2016-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 04/10/2016] [Indexed: 11/15/2022] Open
Abstract
Saphenous vein graft aneurysm (SVGA) is one of the chronic complications after coronary aorta bypass grafting (CABG) and may be caused by atherosclerosis-like phenomena of the vein graft, weakness around the vein valve, rupturing of the suture of the graft anastomosis, or perioperative graft injury. We describe a case of a large, growing saphenous vein graft aneurysm that was followed serially by chest radiography and computed tomography. Eighteen years after CABG, an SVGA (23 × 24 mm) was incidentally detected. The patient was asymptomatic and was followed conservatively. Four years later, coronary computed tomographic angiography showed that the giant aneurysm had grown to 52.1 by 63.8 mm and revealed a second, smaller aneurysm. Finally, the SVG was ultimately resected without bypass via off-pump surgery. Therefore, this case suggested that aggressive treatment that includes surgical intervention should be considered before the aneurysm becomes larger, even if it is asymptomatic.
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Affiliation(s)
- Tadateru Takayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naotaka Akutsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiyuki Oya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hironori Haruta
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Korehito Iida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takaaki Kougo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Mineki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshihiko Nishida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toru Oshima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroaki Hata
- Department of Cardiovascular Surgery Nihon University School of Medicine, Tokyo, Japan
| | - Motomi Shiono
- Department of Cardiovascular Surgery Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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