Percutaneous Treatment of a Large Vein Graft Aneurysm With Covered and Conventional Stents
A 75-year-old man presented with typical angina 13 years after coronary artery bypass grafting. Angiography demonstrated a patent internal mammary graft to the left anterior descending artery and vein graft to the obtuse marginal branch of the left circumflex artery. The large-caliber right coronary graft had a large false aneurysm in its midportion, at the site of a severe stenosis. The aneurysm appeared to compress the graft distally. Three 17-mm polytetrafluoroethylene (PTFE)-covered stents (Abbott Vascular Devices) were each hand-crimped on a 5×20-mm balloon and deployed with overlap across the neck of the aneurysm. Two bare-metal stents (5×28 mm and 5×32 mm) were also deployed with overlap into the covered stents, to splint the PTFE stents within the aneurysm. A minor endoleak was present at the end of the procedure. Repeat angiography 6 weeks later showed complete exclusion of the false aneurysm and a widely patent stented segment (Figure).
Vein graft false aneurysms are uncommon but may develop late after coronary artery bypass grafting surgery; they are usually atherosclerotic in origin. Traditionally, they have been treated by surgical excision or percutaneous coil embolization. This large false aneurysm was treated with multiple balloon-expanded PTFE-covered stents. A covered self-expanding stent might also have been used to exclude the false aneurysm.