Saphenous Vein Graft Aneurysm Successfully Managed With Percutaneous Coiling

Additional Authors

Ashwin Jagadish, Department of Internal Medicine, East Tennessee State University, Johnson City, TN. Shahnawaz Notta, Department of Internal Medicine, East Tennessee State University, Johnson City, TN. Shobha Hiremagalur, Cardiology, Ballad Health CVA Heart Institute, Johnson City, TN. Ahmed Khan, Cardiology, Ballad Health CVA Heart Institute, Johnson City, TN.

Abstract

Coronary artery bypass grafting (CABG) is performed to regain blood flow to an ischemic myocardium. Commonly used graft vessels include saphenous veins from the lower extremities and the left internal mammary artery. Complications can include sternal infections, graft occlusion, or tamponade. An uncommon complication of using a saphenous vein graft (SVG) during CABG is aneurysm formation, seen in 0.07% to 14% of cases. SVG aneurysms can be asymptomatic or result in rupture or death. Symptoms include dyspnea, chest pain, hemoptysis, or rupture. Aneurysms cannot be safely monitored. 20 mm aneurysms can be associated with a complication rate of close to 33%, and 100 mm aneurysms can have up to a 70% complication rate. Imaging for evaluating SVG aneurysms includes cardiac catheterization, computed tomography (CT), magnetic resonance imaging, chest radiographs, or echocardiograms. Treatment can include surgical or percutaneous interventions. A 63-year-old male presented to the emergency department with ongoing chest pain for two days after falling off a ladder. Physical examination revealed slight tenderness to palpation of the anterior and left chest walls. Electrocardiogram revealed atrial flutter with controlled ventricular response. Chest radiograph demonstrated suprahilar mass concerning for aneurysm. CT coronary angiogram revealed large aneurysm and distally occluded SVG. Cardiac catheterization revealed large filling aneurysm. There was 95% stenosis in the SVG to the right posterior descending artery (PDA) and 99% stenosis in the proximal native circumflex artery. Given his history of CABG procedures and debridement for sternal wound infection, percutaneous intervention was pursued. He underwent successful percutaneous intervention of the SVG to the right PDA and the proximal native circumflex artery. He also underwent percutaneous coiling of the SVG aneurysm. Three weeks afterwards, direct current cardioversion successfully converted his atrial flutter to sinus rhythm. CT angiography seventeen months later revealed a completely thrombosed SVG aneurysm and complete SVG proximal occlusion.

Start Time

16-4-2025 9:00 AM

End Time

16-4-2025 11:30 AM

Presentation Type

Poster

Presentation Category

Health

Student Type

Clinical Resident or Fellow

Faculty Mentor

Ahmed Khan

Faculty Department

Ballad Health CVA Heart Institute

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Saphenous Vein Graft Aneurysm Successfully Managed With Percutaneous Coiling

Coronary artery bypass grafting (CABG) is performed to regain blood flow to an ischemic myocardium. Commonly used graft vessels include saphenous veins from the lower extremities and the left internal mammary artery. Complications can include sternal infections, graft occlusion, or tamponade. An uncommon complication of using a saphenous vein graft (SVG) during CABG is aneurysm formation, seen in 0.07% to 14% of cases. SVG aneurysms can be asymptomatic or result in rupture or death. Symptoms include dyspnea, chest pain, hemoptysis, or rupture. Aneurysms cannot be safely monitored. 20 mm aneurysms can be associated with a complication rate of close to 33%, and 100 mm aneurysms can have up to a 70% complication rate. Imaging for evaluating SVG aneurysms includes cardiac catheterization, computed tomography (CT), magnetic resonance imaging, chest radiographs, or echocardiograms. Treatment can include surgical or percutaneous interventions. A 63-year-old male presented to the emergency department with ongoing chest pain for two days after falling off a ladder. Physical examination revealed slight tenderness to palpation of the anterior and left chest walls. Electrocardiogram revealed atrial flutter with controlled ventricular response. Chest radiograph demonstrated suprahilar mass concerning for aneurysm. CT coronary angiogram revealed large aneurysm and distally occluded SVG. Cardiac catheterization revealed large filling aneurysm. There was 95% stenosis in the SVG to the right posterior descending artery (PDA) and 99% stenosis in the proximal native circumflex artery. Given his history of CABG procedures and debridement for sternal wound infection, percutaneous intervention was pursued. He underwent successful percutaneous intervention of the SVG to the right PDA and the proximal native circumflex artery. He also underwent percutaneous coiling of the SVG aneurysm. Three weeks afterwards, direct current cardioversion successfully converted his atrial flutter to sinus rhythm. CT angiography seventeen months later revealed a completely thrombosed SVG aneurysm and complete SVG proximal occlusion.