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Mezzetti E, Maiese A, Spina F, Del Duca F, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Fineschi V. Early Saphenous Vein Graft Aneurysm Rupture: A Not So-Late Complication. Case Report and Comprehensive Literature Review. Biomedicines 2023; 11:biomedicines11010220. [PMID: 36672728 PMCID: PMC9855650 DOI: 10.3390/biomedicines11010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Saphenous vein graft (SVG) is a cardiac surgical practice used to create a cardiac bypass in cases of coronary artery obstruction. It consists of a surgical procedure that involves the creation of an aorto-coronary communication by a venous conduit (saphenous vein) to bypass coronary stenosis and allow cardiac revascularization. This practice can be affected by early and late complications. The most feared complication is graft aneurysm or pseudoaneurysm degeneration and rupture which are considered late complications. This paper presents a rare case of SVG aneurysmal rupture that occurred 24 h after surgery and a review of the literature to provide a general look at the state of knowledge. MATERIALS AND METHODS The systematic review was carried out using the guidelines according to the PRISMA method. RESULTS Cases of aneurysmal rupture have never been described prior to one month after surgery. The male sex and subjects under 45 are the most affected by this complication. Death occurs in less than half of the cases, being more frequent in young people. Performing a CT or angio-CT examination led to the diagnosis. CONCLUSIONS It is impossible to estimate the implanted vessel's quality, so postoperative follow-up is fundamental. Transesophageal ultrasound can be useful, and hematochemical tests are valuable early diagnostic tools, whrease CT and angio-CT can be useful even months after surgery. Forensic analysis should always perform an autopsy and graft histological examination.
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Affiliation(s)
- Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Federica Spina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
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Saphenous Vein Graft Aneurysm after Drug-Eluting Stent Implantation: Treatment by Covered Stent. Case Rep Cardiol 2021; 2021:2360804. [PMID: 34777875 PMCID: PMC8589514 DOI: 10.1155/2021/2360804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Saphenous vein graft aneurysms (SVGAs) occur as a rare complication of coronary artery bypass graft but increases the risk of morbidity and mortality. Atherosclerosis is considered to be the most common cause of saphenous vein graft aneurysms. Other etiologies include infections, varicosities of vein grafts, and surgical technical issues. These aneurysms usually present as an incidental finding of a mediastinal or cardiac mass on chest radiograph. Symptomatic aneurysms may present with a wide variety of clinical manifestations such as chest pain/angina, shortness of breath, and myocardial infarction. Treatment options of SVG aneurysms include surgery, percutaneous intervention (including vascular plugs, covered stents, and embolization coils), and conservative management. Herein, we describe a case of a saphenous vein graft aneurysm that developed after percutaneous intervention, which has never been described, to our knowledge, in the previous literature. The aneurysm was treated with polytetrafluoroethylene covered stent implantation.
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Rahman MN, Khan BK, Hasan BS. Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass. Catheter Cardiovasc Interv 2019; 94:984-988. [PMID: 31424620 DOI: 10.1002/ccd.28441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
A 72-year-old man with prior history of coronary artery bypass grafting and sternal wire infection presented with non-ST-segment elevation myocardial infarction. His coronary angiogram revealed stenosis of the distal left main coronary artery (LMCA) and a pseudoaneurysm of saphenous venous graft (SVG) to right posterior descending artery. Patient developed ventricular fibrillation during admission, and postcardiopulmonary resuscitation, a pulsatile chest mass was observed which was diagnosed with computed tomography as a chest wall collection resulting from rupture of the pseudo-aneurysm. He underwent percutaneous coronary intervention of the LMCA with drug-eluting stents followed by successful coil embolization of the SVG pseudoaneurysm. Patient had an uneventful recovery postprocedure.
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Affiliation(s)
| | - Bilal K Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Babar S Hasan
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Jawitz OK, Keenan JE, Perna J, Milano CA. Successful aneurysm resection and coronary artery revascularization following saphenous vein graft aneurysm rupture. Eur J Cardiothorac Surg 2019; 55:585-586. [PMID: 30060015 DOI: 10.1093/ejcts/ezy270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 07/03/2018] [Indexed: 11/14/2022] Open
Abstract
Saphenous vein graft aneurysms after coronary artery bypass grafting (CABG) have been rarely reported. Their incidence and natural history are poorly defined. Herein, we present a patient who presented acutely with contained rupture of a large saphenous vein graft aneurysm 12 years after CABG, which was successfully managed with open aneurysm resection and regrafting.
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Affiliation(s)
- Oliver K Jawitz
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey E Keenan
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Perna
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Knoery C, Ashcroft M, Smith JA, Leslie SJ. Percutaneous treatment of a massive saphenous vein graft aneurysm. Catheter Cardiovasc Interv 2018; 93:923-926. [PMID: 30592136 DOI: 10.1002/ccd.28040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/06/2022]
Abstract
Saphenous vein graft (SVG) aneurysms are a rare, frequently late presenting, potentially fatal complication of coronary artery bypass graft (CABG) surgery. They are often discovered incidentally during radiological tasks such as chest x-ray or CT but can present clinically with symptoms such as worsening angina and breathlessness as well as complications such as rupture or myocardial infarction. Given the risks if left untreated, consideration should be given to treatment either through percutaneous routes or open surgery. However, because of a lack of strong evidence, there are no definitive guidelines on the treatment of SVG aneurysms. We describe a patient with an extensive cardiac surgical history who presented with angina and breathlessness and was found to have a large SVG aneurysm, subsequently successfully treated with percutaneous coronary intervention with covered stents.
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Affiliation(s)
- Charles Knoery
- Raigmore Hospital, Inverness, United Kingdom.,Department of Diabetes & Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, United Kingdom
| | | | | | - Stephen J Leslie
- Raigmore Hospital, Inverness, United Kingdom.,Department of Diabetes & Cardiovascular Science, University of the Highlands and Islands, Centre for Health Science, Inverness, United Kingdom
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Yamaguchi T, Miyamoto T, Kawahatsu K, Nozato T. Very early great saphenous vein graft aneurysm treated by percutaneous coronary intervention under ChromaFlo imaging guidance. BMJ Case Rep 2017; 2017:bcr-2017-220443. [PMID: 28729378 DOI: 10.1136/bcr-2017-220443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old man, who had undergone coronary artery bypass grafting (CABG) 10 days prior, presented with a great saphenous vein graft aneurysm (SVGA). CT revealed the increasing size of the aneurysm. Since the SVGA occurred immediately after CABG and there were no other complications, the aneurysm was treated percutaneously. While intravascular ultrasonography (IVUS) and optical coherence tomography failed to detect the entry point, an IVUS catheter with the addition of ChromaFlo imaging clearly revealed the entry point, size and length of the SVGA. To prevent migration and edge restenosis associated with covered stents, the covered stent (3.0×19 mm) was superimposed on a drug-eluting stent (3.0×28 mm) that covered the entry site. A follow-up study demonstrated the absence of flow into the aneurysm.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takamichi Miyamoto
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kandoh Kawahatsu
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
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Kar S, Webel RR. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications. Catheter Cardiovasc Interv 2017; 90:589-597. [PMID: 28258964 DOI: 10.1002/ccd.26997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Richard R Webel
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
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Park SJ, Park JY, Jung J, Hong YS, Lee CJ, Lim SH. Vanishing Venous Coronary Artery Bypass Grafts after Sepsis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:387-391. [PMID: 27734001 PMCID: PMC5059127 DOI: 10.5090/kjtcs.2016.49.5.387] [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: 09/30/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication.
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Affiliation(s)
- Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Ji Ye Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - You Sun Hong
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Cheol Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Sang Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
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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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Datta S, Manoly I, Karangelis D, Hasan R. Pseudoaneurysm of the Right Internal Mammary Artery Post Vacuum-Assisted Closure Therapy: A Rare Complication and Literature Review. Ann Vasc Surg 2015; 31:207.e1-3. [PMID: 26597235 DOI: 10.1016/j.avsg.2015.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
Abstract
Vacuum-assisted closure (VAC) therapy in the management of sternal wound infection post cardiac surgery has gained popularity since last decade. It is very cost effective and has survival benefit compared with conventional management. Although there are few complications associated with VAC therapy including right ventricular free wall rupture and infectious erosion to aorta, there are now isolated reports of vein graft pseudoaneurysm associated with it. We describe an extremely rare complication of right internal mammary artery pseudoaneurysm post VAC therapy in a 56-year-old man which was successfully managed surgically. We also did a literature review on the possible complications of VAC therapy post cardiac surgery and its management.
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Affiliation(s)
- Subir Datta
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Imthiaz Manoly
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Dimos Karangelis
- Central Manchester University Hospitals Foundation Trust, Manchester, UK.
| | - Ragheb Hasan
- Central Manchester University Hospitals Foundation Trust, Manchester, UK
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Ali N, Mathew T, Henderson R, Agostoni P, Werner N. How should I treat an asymptomatic enlarging giant saphenous vein graft aneurysm? EUROINTERVENTION 2014; 9:1244-7. [PMID: 24561741 DOI: 10.4244/eijv9i10a209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nadine Ali
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom
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Marmagkiolis K, Grines C, Bilodeau L. Current percutaneous treatment strategies for saphenous vein graft disease. Catheter Cardiovasc Interv 2013; 82:406-13. [PMID: 22777812 DOI: 10.1002/ccd.24554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/30/2012] [Indexed: 12/16/2022]
Abstract
Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.
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Affiliation(s)
- Kostantinos Marmagkiolis
- William Beaumont Hospital, Royal Oak, Michigan; Montreal Heart Institute, Montreal, Quebec, Canada
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Stent-graft repair of a giant saphenous vein graft aneurysm. Heart Lung Circ 2012; 21:828-30. [DOI: 10.1016/j.hlc.2012.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 04/16/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Fistula From Aneurysmal Saphenous Vein Graft to Right Atrium Treated with Covered Stents. Heart Lung Circ 2010; 19:465-9. [DOI: 10.1016/j.hlc.2010.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 04/04/2010] [Accepted: 05/03/2010] [Indexed: 11/17/2022]
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Kumar A, Santana D, Jenkins LA. Closure of a giant saphenous vein graft aneurysm with embolization coil. Cardiol Res Pract 2009; 2009:748272. [PMID: 19946632 PMCID: PMC2778173 DOI: 10.4061/2009/748272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 08/18/2009] [Indexed: 12/02/2022] Open
Abstract
Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 × 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention.
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Affiliation(s)
- Ashwani Kumar
- Division of Cardiology, Department of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA
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