Multislice Spiral Computed Tomography–Assisted Vein Graft Stenting
A 73-year-old woman presented with angina pectoris 2 years after bypass surgery with left internal mammary artery to left anterior descending coronary artery and a saphenous vein graft (SVG) to the obtuse marginal branch (OM) and the posterior descending artery (PDA).
On admission, the chest radiograph showed an enlarged mediastinum; no pleural effusion was present. An ECG-gated multislice spiral computed tomography (MSCT) was performed. Axial (Figure 1A) and 3D volume–rendered (Figure 1B) images showed a subacute Stanford type A aortic dissection and a severe stenosis of the SVG (circle in Figure 1B); the SVG takeoff (arrow in Figure 1A) from the true lumen was also clearly documented.
Angiography confirmed a severe stenosis in the mid-SVG (circle) (Figure 2A); the left internal mammary artery was patent. A covered stent was successfully implanted, and a 6-month course of aspirin+clopidogrel therapy was recommended.
Seven months later, the patient was asymptomatic, and a follow-up MSCT (Figure 2B) showed persistence of the false lumen in the ascending aorta and the covered stent in the mid-SVG (arrowhead).
MSCT provided useful information about spatial relationships between the aortic flap and the takeoff of the SVG, and it can be used as a noninvasive diagnostic tool for follow-up evaluation of graft patency.
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 the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.