Pulmonary Procedures |

Bilateral Saphenous Vein Graft Aneurysms FREE TO VIEW

Michael Tatusov, MD
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Medstar Washington Hospital Center, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):840A. doi:10.1378/chest.2243775
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SESSION TITLE: Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: More than 50 years have passed since CABG was first successfully performed in humans. Despite many improvements in surgical technique, complications of CABG continue to occur. Here, we present a rare case of bilateral saphenous vein graft aneurysm as a late complication of CABG.

CASE PRESENTATION: 77 yo man with CAD status post CABG 12 years ago, presented for evaluation of chest pain and dyspnea. On examination, his vitals were stable and his exam was unremarkable. Basic labs, including cardiac enzymes, were unrevealing. A chest x-ray demonstrated fullness in the right hilum worrisome for a mass (1). CT of the chest with contrast confirmed two large anterior mediastinal masses as well as mediastinal lymphadenopathy. Percutaneous CT guided biopsy showed only blood and was complicated by a hemothorax. Further work up with bronchoscopy and biopsy was non diagnostic. Coronary CT angiography revealed aneurysms of two coronary bypass vein grafts (2). The right graft was patent to the RCA, but the left was occluded. Patient was offered surgical treatment, but he declined, opting for conservative management. He is doing well 1 year after initial diagnosis.

DISCUSSION: Saphenous Vein Graft Aneurysm (SVGA) is a rare complication of CABG. The overall incidence is likely less than 0.5% of grafts. Proposed etiologies include exposure to arterial pressures, atherosclerotic changes, infection, and technical factors during harvest and transplant. Typical presentation is with chest pain, dyspnea, and MI, but a large number of patients are asymptomatic. Multiple studies have documented aneurysmal enlargement, however the rate of growth is variable. Large aneurysms have higher rates of mechanical complications, but increasing size has not been demonstrated to increase the risk of rupture or death. Treatment data is limited, with some case series advocating conservative management 1, and others suggesting surgical treatment 2. Recently, increasing percutaneous options are becoming available.

CONCLUSIONS: Anterior mediastinal mass with a history of CABG should raise suspicion for SVGA. More data is needed to determine optimal treatment.

Reference #1: Dieter, R. S., et al. (2003). "Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series." Cardiovasc Surg 11(6): 507-513.

Reference #2: Sareyyupoglu, B., et al. (2009). "Surgical treatment of saphenous vein graft aneurysms after coronary artery revascularization." Ann Thorac Surg 88(6): 1801-1805.

DISCLOSURE: The following authors have nothing to disclose: Michael Tatusov

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