Ruptured saphenous vein graft pseudoaneurysm successfully treated with covered stents

Abstract

Saphenous vein graft (SVG) pseudoaneurysms are rare complications following coronary bypass graft surgery. A 46-year-old man presented with streptococcal infectious endocarditis and needed sequential operations for aortic root reconstruction. Shortly after the surgeries, a composite SVG on the right coronary artery developed a ruptured pseudoaneurysm, which was successfully treated using covered stents.

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

“…Patients may present with chest pain, heart failure, or mass effect due to the compression of cardiac chambers and mediastinal structures . Pseudoaneurysm rupture has also been described in case reports . Cases presenting early after surgery are believed to be due to poor surgical technique, infection, and inflammation whereas the etiology in late presenting cases is believed to be delayed suture dehiscence .…”

“…4,5 Pseudoaneurysm rupture has also been described in case reports. 6 Cases presenting early after surgery are believed to be due to poor surgical technique, infection, and inflammation whereas the etiology in late presenting cases is believed to be delayed suture dehiscence. 7 Our patient had distal LMCA stenosis in addition to a pseudoaneurysm which eventually ruptured.…”

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

“…However, endovascular techniques are now more frequently utilized including stent grafts or coil embolization. 3,7,9,16,17 We report a case of an aneurysmal vein graft with subsequent rupture and formation of a large pseudoaneurysm. The AMPLATZER muscular VSD Occluder (St Jude's Medical, St. Paul, MN) was utilized successfully to occlude the aortic origin of the graft.…”

“…Pseudoaneurysms of bypass grafts following coronary artery bypass graft (CABG) occur very rarely. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] They are generally preceded by aneurysmal dilatation of the graft secondary to degenerative changes many years after CABG. 12 Ramirez et al 12 noted that 68.5% of the grafts that develop aneurysmal changes post CABG do so after 10 years of bypass surgery and 8.1% will eventually rupture.…”

“…Other etiologies also include intervention on the graft, 9 inflammatory disease, 15 or infection. 3 Treatment of vein graft pseudoaneurysm is generally surgical. However, endovascular techniques are now more frequently utilized including stent grafts or coil embolization.…”