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Aneurysm of an autologous aorta to right coronary artery reverse saphenous vein graft presenting as a mediastinal mass: a case report.

Pulling TM, Uyesugi WY - Cases J (2008)

Bottom Line: Aneurysmal dilation of saphenous vein grafts is a relatively rare complication of the now common surgical procedure of coronary artery bypass graft (CABG) surgery.The causes of this dramatic increase is likely multifactorial, however, in the author's opinion, likely reflects the increased sophistication and utilization of cross sectional imaging modalities.Regardless of the true prevalence of the condition, there is little debate that the potential for serious morbidity and mortality in this patient population is significant, and that increased detection and discussion of viable therapeutic options is critical. 1 Therefore, we present a case report and discussion of a patient with symptomatic cardiac ischemia, found to have a large saphenous vein graft aneurysm (SVGA) on coronary CTA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, MCHK-DR, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA. thomas.pullingmd@gmail.com.

ABSTRACT
Aneurysmal dilation of saphenous vein grafts is a relatively rare complication of the now common surgical procedure of coronary artery bypass graft (CABG) surgery. The true prevalence of this condition is not clear, however, literature review by Jorgensen et. al. between 1975 and 2002 revealed only 76 published cases. 1 Recent review of literature, utilizing OVID (search terms: saphenous vein, aneurysm, graft, pseudoaneurysm, coronary bypass) suggests a significantly higher prevalence with 14 such cases published in a variety of multinational journals during the period of 2006 to April 2007. The causes of this dramatic increase is likely multifactorial, however, in the author's opinion, likely reflects the increased sophistication and utilization of cross sectional imaging modalities. Regardless of the true prevalence of the condition, there is little debate that the potential for serious morbidity and mortality in this patient population is significant, and that increased detection and discussion of viable therapeutic options is critical. 1 Therefore, we present a case report and discussion of a patient with symptomatic cardiac ischemia, found to have a large saphenous vein graft aneurysm (SVGA) on coronary CTA.

No MeSH data available.


Related in: MedlinePlus

Axial image from CTA demonstrating a 3.9 cm aneurysm of the proximal aspect of the saphenous vein graft in the right AV groove (white arrow). Contrast opacification is seen in the lumen with mass effect on the adjacent native RCA (black arrow).
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Figure 3: Axial image from CTA demonstrating a 3.9 cm aneurysm of the proximal aspect of the saphenous vein graft in the right AV groove (white arrow). Contrast opacification is seen in the lumen with mass effect on the adjacent native RCA (black arrow).

Mentions: Gated CT Coronary angiography was subsequently performed utilizing a GE 16 slice MDCT and approximately 125 cc of Visipaque 320. Test conditions were optimal with a normal sinus rhythm and heart rate between 54 and 55 bpm. A 3.9 cm fusiform aneurysm of an anterior aorta to RCA reverse saphenous vein graft was identified just distal to the origin of the native RCA with severe proximal narrowing of the graft (3.5 mm luminal diameter), but patent contrast opacification through the distal RCA (Figure 2, 3, 4, 5, and 6). The aneurysm wall is dominated by laminated appearing thrombus, comprising greater than fifty percent of the diameter (largest luminal diameter 1.6 cm). Significant mass effect with lateral and posterior displacement of the native RCA was identified. Thrombosed SVG's were seen from the anterior aorta to the second diagonal branch of the LAD and the second obtuse marginal branch of the LCA. A patent LIMA to LAD graft with anastamosis distal to the third diagonal branch was seen.


Aneurysm of an autologous aorta to right coronary artery reverse saphenous vein graft presenting as a mediastinal mass: a case report.

Pulling TM, Uyesugi WY - Cases J (2008)

Axial image from CTA demonstrating a 3.9 cm aneurysm of the proximal aspect of the saphenous vein graft in the right AV groove (white arrow). Contrast opacification is seen in the lumen with mass effect on the adjacent native RCA (black arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2605764&req=5

Figure 3: Axial image from CTA demonstrating a 3.9 cm aneurysm of the proximal aspect of the saphenous vein graft in the right AV groove (white arrow). Contrast opacification is seen in the lumen with mass effect on the adjacent native RCA (black arrow).
Mentions: Gated CT Coronary angiography was subsequently performed utilizing a GE 16 slice MDCT and approximately 125 cc of Visipaque 320. Test conditions were optimal with a normal sinus rhythm and heart rate between 54 and 55 bpm. A 3.9 cm fusiform aneurysm of an anterior aorta to RCA reverse saphenous vein graft was identified just distal to the origin of the native RCA with severe proximal narrowing of the graft (3.5 mm luminal diameter), but patent contrast opacification through the distal RCA (Figure 2, 3, 4, 5, and 6). The aneurysm wall is dominated by laminated appearing thrombus, comprising greater than fifty percent of the diameter (largest luminal diameter 1.6 cm). Significant mass effect with lateral and posterior displacement of the native RCA was identified. Thrombosed SVG's were seen from the anterior aorta to the second diagonal branch of the LAD and the second obtuse marginal branch of the LCA. A patent LIMA to LAD graft with anastamosis distal to the third diagonal branch was seen.

Bottom Line: Aneurysmal dilation of saphenous vein grafts is a relatively rare complication of the now common surgical procedure of coronary artery bypass graft (CABG) surgery.The causes of this dramatic increase is likely multifactorial, however, in the author's opinion, likely reflects the increased sophistication and utilization of cross sectional imaging modalities.Regardless of the true prevalence of the condition, there is little debate that the potential for serious morbidity and mortality in this patient population is significant, and that increased detection and discussion of viable therapeutic options is critical. 1 Therefore, we present a case report and discussion of a patient with symptomatic cardiac ischemia, found to have a large saphenous vein graft aneurysm (SVGA) on coronary CTA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, MCHK-DR, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA. thomas.pullingmd@gmail.com.

ABSTRACT
Aneurysmal dilation of saphenous vein grafts is a relatively rare complication of the now common surgical procedure of coronary artery bypass graft (CABG) surgery. The true prevalence of this condition is not clear, however, literature review by Jorgensen et. al. between 1975 and 2002 revealed only 76 published cases. 1 Recent review of literature, utilizing OVID (search terms: saphenous vein, aneurysm, graft, pseudoaneurysm, coronary bypass) suggests a significantly higher prevalence with 14 such cases published in a variety of multinational journals during the period of 2006 to April 2007. The causes of this dramatic increase is likely multifactorial, however, in the author's opinion, likely reflects the increased sophistication and utilization of cross sectional imaging modalities. Regardless of the true prevalence of the condition, there is little debate that the potential for serious morbidity and mortality in this patient population is significant, and that increased detection and discussion of viable therapeutic options is critical. 1 Therefore, we present a case report and discussion of a patient with symptomatic cardiac ischemia, found to have a large saphenous vein graft aneurysm (SVGA) on coronary CTA.

No MeSH data available.


Related in: MedlinePlus