Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations

Abstract

While coronary artery bypass grafting remains an essential component of revascularization therapy, the use of venous conduits in the form of saphenous vein grafts is associated with a number of late sequelae, including graft stenosis and occlusion. The recognition of saphenous vein graft aneurysm, typically a late complication, may be associated with adverse outcomes. We describe the percutaneous therapy of saphenous vein graft aneurysm, utilizing contemporary devices, including newer generation covered stents, and the use of devices more commonly used in peripheral vascular intervention, reflecting the dilated nature of vein grafts. Saphenous vein graft aneurysm can be successfully treated with percutaneous therapy, avoiding the risk of repeat sternotomy and associated morbidity. The use of new generation covered stents has not been previously well reported; however, it may have an important role in the treatment of coronary artery and saphenous vein graft aneurysm. Awareness of the role of covered stents used in both coronary and peripheral intervention and the advantages of new generation devices are essential to allow optimal therapy of this uncommon, late complication. The role and potential benefits of new generation covered stents are discussed with a review of the existing literature.

Case Report on Saphenous Vein Graft Aneurysm with Fistula Development to The Right Atrium

“…Proximal and distal ends were sealed using continuous sutures of propylene monofilaments. Although mild SVGAs are very common, with an incidence of approximately 14% within five to seven years after CABGs, clinically significant SVGAs are rare (Khan et al, 2019;Gruberg et al, 1999;Kim et al, 1983). Pseudoaneurysms of a saphenous vein graft is more frequently symptomatic with recurrent chest pain a common presentation.…”

“…Aneurysms are organized into categories of true versus false and early versus late (Ramirez et al, 2012). While mild saphenous vein graft aneurysms (SVGA) are common, clinically significant SVGAs are rare with complicated forms presenting as myocardial infarction and fistula formation to adjacent structures (Khan et al, 2019;Gruberg et al, 1999;Kim et al, 1983;Memon et al, 2003;Benchimol et al, 1975). Diagnosis can be confirmed by coronary angiography or computed tomography coronary angiogram with contrast (Khan et al, 2019;Memon et al, 2003).…”

“…While mild saphenous vein graft aneurysms (SVGA) are common, clinically significant SVGAs are rare with complicated forms presenting as myocardial infarction and fistula formation to adjacent structures (Khan et al, 2019;Gruberg et al, 1999;Kim et al, 1983;Memon et al, 2003;Benchimol et al, 1975). Diagnosis can be confirmed by coronary angiography or computed tomography coronary angiogram with contrast (Khan et al, 2019;Memon et al, 2003). The options for treatment of SVGAs include medical management, percutaneous interventions, and surgical repair (Ramirez et al, 2012;Khan…”

“…Diagnosis can be confirmed by coronary angiography or computed tomography coronary angiogram with contrast (Khan et al, 2019;Memon et al, 2003). The options for treatment of SVGAs include medical management, percutaneous interventions, and surgical repair (Ramirez et al, 2012;Khan…”