This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cadaret, L. Articles by Richenbacher, W. Search for Related Content PubMed PubMed Citation Articles by Cadaret, L. Articles by Richenbacher, W. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections CT and MRI CV surgery: coronary artery disease CV surgery: other

(Circulation. 2000;101:1075.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Saphenous Vein Graft Aneurysm

Linda Cadaret, MD; William Cotts, MD; Wayne Richenbacher, MD

From the Divisions of Cardiology and Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City.

Correspondence to Linda Cadaret, MD, Division of Cardiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, Iowa 52242-1091.

A58-year-old white woman who had undergone 3-vessel coronary artery bypass graft surgery in 1988 presented with a 5-month history of chest pressure at rest. At the time of her coronary artery bypass operation, the left internal mammary artery (LIMA) was used to graft the left anterior descending coronary artery (LAD). Separate saphenous vein grafts (SVGs) were placed to the obtuse marginal branch (OM) of the left circumflex (LCx) and posterior descending (PDA) coronary arteries.

A chest roentgenogram revealed a mass in the middle mediastinum near the left pulmonary artery (Figure 1). Computed tomography (CT) of the patient’s chest identified the mass as a 7x7x4-cm aneurysm of the SVG to the OM (Figure 2). The aneurysm contained swirling contrast and laminated thrombus. Also, the aneurysm compressed the left pulmonary artery. Coronary angiography revealed a right-dominant system with a normal left main coronary artery. There was an 80% stenosis of the mid LAD and total occlusion of the proximal LCx and right coronary arteries. There was a 70% stenosis of the SVG to the OM, with a mid/distal aneurysm containing thrombus. There was an 80% stenosis of the SVG to the PDA and severe diffuse disease of the LIMA.

View larger version (143K): [in this window] [in a new window]   Figure 1. Chest roentgenogram revealing middle mediastinal mass (arrows).

View larger version (95K): [in this window] [in a new window]   Figure 2. CT of patient’s chest. Vein graft aneurysm contains laminated thrombus and an eccentric, contrast-filled lumen (arrows).

At surgery, the LAD and PDA were bypassed with SVGs. The aneurysm of the SVG to the OM was resected (Figure 3). The diminutive OM was too small to be regrafted. The aneurysm contained laminated thrombus and an eccentric channel for blood flow (Figure 4). The patient recovered uneventfully and was discharged on postoperative day 6.

View larger version (136K): [in this window] [in a new window]   Figure 3. Intraoperative view of mediastinum taken from right side of operating table with patient’s head to left. Proximal end of obtuse marginal SVG is normal in caliber. Aneurysmal midportion of graft (AN, arrows) is visible between mammary artery pedicle and reflected pericardium (P, arrowheads).

View larger version (172K): [in this window] [in a new window]   Figure 4. Cross section through resected aneurysm. Aneurysm is filled with thrombus at various stages of organization, and channel for blood flow is eccentric (arrows).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				J. A. Quin, I. B. Cetindag, V. Mukerji, R. P. Embrey, A. L. Grasch, and S. R. Hazelrigg Letter to the Editor Angiology, September 1, 2004; 55(5): 587 - 588. [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cadaret, L. Articles by Richenbacher, W. Search for Related Content PubMed PubMed Citation Articles by Cadaret, L. Articles by Richenbacher, W. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections CT and MRI CV surgery: coronary artery disease CV surgery: other