Giant Saphenous Vein Coronary Artery Bypass Graft Aneurysm
Andreas Wahl2, Eike Nagel1, Ingo Paetsch1
1Cardiology, German Heart Institute Berlin, Berlin, Germany; 2Cardiology, Swiss Cardiovascular Center Bern, Bern, Switzerland
A 60 year-old asymptomatic man with a single aortocoronary saphenous vein graft to the left anterior descending coronary artery 16 years ago was referred for evaluation of mediastinal enlargement detected on routine chest x-ray (Fig.1 A). MRI identified a large aneurysm of the saphenous vein graft (70x75 mm; Fig. 1 B and C). The graft was found to be patent, with several layers of thrombus filling the aneurysm. Preoperative coronary angiography confirmed these findings (Fig. 1D). Surgical resection of the aneurysm and redo bypass grafting were successfully performed, and the patient recovered without further problems at one year follow-up. Saphenous vein graft aneurysms constitute a rare complication of coronary artery bypass surgery, which may result in aneurysmal rupture, fistulous communication, embolization or myocardial infarction. Treatment of large aneurysms is mostly surgical. Follow-up of smaller asymptomatic aneurysms has been successfully performed using CT or MRI.
Figure legend
Figure 1.(A) Chest X-ray showing a large mediastinal mass located anterior to the aorta. (B) 3-dimensional, contrast-enhanced MR angiography. The lumen of the complete single aortocoronary vein graft is depicted showing a large aneurysmal dilatation in its mid portion with the proximal and distal vein graft being patent. (C) T1-weighted MR blackblood scan. The large mediastinal mass consists of several layers of thrombotic material with a patent graft segment in this particular slice orientation. (D) Conventional coronary angiography confirmed the aneurysm of the aortocoronary vein graft.
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