Images in Clinical Medicine

Aneurysm of a Saphenous-Vein Bypass Graft

Donald Sutherland, M.D., and Peter C. Block, M.D.

N Engl J Med 2001; 344:1139April 12, 2001

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Figure 1 A 75-year-old man who was taking 8 mg of prednisone per day for systemic lupus erythematosus was admitted for the evaluation of an enlarging chest mass. Seventeen years earlier he had undergone aortocoronary saphenous-vein grafting. Two years before presentation, he had coronary angiography for recurrent chest pain. A chest x-ray film showed a small, rounded irregularity of the right lateral aspect of the cardiac silhouette (arrows in Panel A). A calcified 90 percent stenosis of the proximal native right coronary artery was found. The right saphenous-vein graft was patent and had an aneurysm measuring 8 by 10 mm that was 2 cm from the origin of the graft. Stenting of the stenotic segment restored normal blood flow, and the patient's chest pain disappeared. Two years later, a follow-up chest x-ray film showed that the mass had enlarged (arrows in Panel B). The native right coronary artery was still patent, but the graft had a rounded aneurysm (A in Panel C) that was 6 to 7 cm in diameter. Contrast material slowly filled the distal segment of the graft (arrows in Panel C). Wire coils were advanced through a catheter into the graft distal and proximal to the aneurysm. Within 20 minutes, flow into the proximal portion of the aneurysm was substantially reduced. No distal flow was seen. Subsequent imaging studies showed no activity in the region of the thrombosed aneurysm. No chest pain occurred during the subsequent 14 months of follow-up.

Donald Sutherland, M.D.
Peter C. Block, M.D.
Providence St. Vincent Medical Center, Portland, OR 97225-6603

Citing Articles (3)

Citing Articles

1. 1

   Ilias Mylonas, Yoshihito Sakata, Michael H. Salinger, Ted Feldman. (2006) Successful closure of a giant true saphenous vein graft aneurysm using the Amplatzer vascular plug. Catheterization and Cardiovascular Interventions 67:4, 611-616
   CrossRef

2. 2

   André J Duerinckx. (2004) Plain film / MR imaging correlation in heart disease. Radiologic Clinics of North America 42:3, 515-541
   CrossRef

3. 3

   ABDUL-QADIR MEMON, RAYMOND I. HUANG, FRANK MARCUS, LYNDON XAVIER, JOSEPH ALPERT. (2003) Saphenous Vein Graft Aneurysm. Cardiology in Review 11:1, 26-34
   CrossRef