Early Saphenous Vein Graft Aneurysm Rupture: A Not So-Late Complication. Case Report and Comprehensive Literature Review

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.

Aneurysmatic Dilation of Autovenous Conduit After Coronary Bypass Graft: Clinical Case

“…Mezzetti Е.c соавт. в своем обзоре 2023 года описали все случаи, доступные в литературе, разрывов аутовенозных кондуитов [7]. Согласно проанализированным данным аневризматические и псевдоаневризматические поражения обычно чаще встречаются у мужчин, при этом у женщин чаще наблюдаются летальные исходы.…”

“…В качестве осложнений могут возникать сдавление нативных коронарных сосудов, дистальная эмболизация, ишемизация миокарда, сдавление правого предсердия или образование свища и его разрыв в правое предсердие [5,6]. Клинически при аневризме кондуита чаще всего может возникнуть стенокардия (13-24 %), инфаркт миокарда (12-23 %), реже -приступы кашля или внезапная смерть [6,7]. Разрыв происходит лишь в 8 % случаев с катастрофическими осложнениями и летальным исходом.…”