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Saphenous Vein Graft Aneurysms Differential Diagnoses

  • Author: Jesse P Jorgensen, MD; Chief Editor: Eric H Yang, MD  more...
 
Updated: Nov 10, 2014
 
 

Diagnostic Considerations

Important considerations

Patients who have had coronary artery revascularization with vein grafts and present with angina or infarction should have a thorough cardiac workup to exclude recurrent disease or aneurysm development.

The diagnosis of saphenous vein graft aneurysm (SVGA) requires a high index of suspicion and may require multiple imaging modalities for the diagnosis to be made.

During surgery, care must be taken to avoid manipulation of the aneurysm, as this may dislodge thrombus and result in distal embolization.

Biopsy of a mediastinal mass without knowledge that it represents an SVGA could be catastrophic.

Other problems to be considered

Other conditions to consider in the differential diagnosis of patients with suspected SVGA include lymphoma and pericardial cyst.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Jesse P Jorgensen, MD Fellow, Department of Cardiology, Emory University School of Medicine

Jesse P Jorgensen, MD is a member of the following medical societies: American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.

Coauthor(s)

Tarek Helmy, MD, FACC, FSCAI Professor of Medicine, Division of Cardiology, Director of Cardiac Catheterization Laboratory, University of Cincinnati School of Medicine

Tarek Helmy, MD, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven J Compton, MD, FACC, FACP, FHRS Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Physicians, American Heart Association, American Medical Association, Heart Rhythm Society, Alaska State Medical Association, American College of Cardiology

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic Arizona

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Additional Contributors

Craig T Basson, MD, PhD Translational Medicine Head – Cardiovascular, Translational Medicine Head - Diabetes and Metabolism, Novartis Institutes for BioMedical Research

Craig T Basson, MD, PhD is a member of the following medical societies: American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author Christian Birkedal, MD, and J Thomas Williams, MD, to the development and writing of this article.

References
  1. Riahi M, Vasu CM, Tomatis LA, et al. Aneurysm of saphenous vein bypass graft to coronary artery. J Thorac Cardiovasc Surg. 1975 Aug. 70(2):358-9. [Medline].

  2. Elgharably H, Kursbaum A, Flamm SD, et al. Mediastinal mass presented 36 years after coronary bypass grafting: is vein graft pseudoaneurysm a differential diagnosis?. Eur J Cardiothorac Surg. 2014 Sep 25. [Medline].

  3. Sherry CS, Harms SE. MR imaging of pseudoaneurysms in aortocoronary bypass graft. J Comput Assist Tomogr. 1989 May-Jun. 13(3):426-9. [Medline].

  4. Khabeishvili G, Shaburishvili T, Wann S, et al. Saphenous vein graft pseudoaneurysm: diagnosis by transesophageal echocardiography and magnetic resonance imaging. J Am Soc Echocardiogr. 1995 May-Jun. 8(3):338-40. [Medline].

  5. Benari B, Erel J, Allen HN, et al. Aneurysm of saphenous vein bypass graft detected by first-pass radionuclide ventriculography. Am Heart J. 1997 Jan. 133(1):133-6. [Medline].

  6. Ennis BM, Zientek DM, Ruggie NT, et al. Characterization of a saphenous vein graft aneurysm by intravascular ultrasound and computerized three-dimensional reconstruction. Cathet Cardiovasc Diagn. 1993 Apr. 28(4):328-31. [Medline].

  7. Dieter RS, Patel AK, Yandow D, Pacanowski JP Jr, Bhattacharya A, Gimelli G, et al. Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series. Cardiovasc Surg. 2003 Dec. 11(6):507-13. [Medline].

  8. Ishishita Y, Tanikawa R, Noda K, Kubota H, Izumi N, Katsuno M, et al. Universal Extracranial-Intracranial Graft Bypass for Large or Giant Internal Carotid Aneurysms: Techniques and Results in 38 Consecutive Patients. World Neurosurg. 2013 Feb 20. [Medline].

  9. Rezq A, Politi L, Sangiorgi G. Long-term outcome of percutaneous exclusion of huge saphenous vein graft aneurysms using peripheral covered-stents as alternative to surgical repair. J Invasive Cardiol. 2012 Dec. 24(12):689-91. [Medline].

  10. Bosmans JM, Claeys MJ, Dilling D, Vrints CJ. Unsuccessful long-term outcome after treatment of a vein graft false aneurysm with a polytetrafluoethylene-coated Jostent. Catheter Cardiovasc Interv. 2000 May. 50(1):105-8. [Medline].

  11. Brilakis ES, Lichtenwalter C, de Lemos JA, Roesle M, Obel O, Haagen D, et al. A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial. J Am Coll Cardiol. 2009 Mar 17. 53(11):919-28. [Medline].

  12. Mylonas I, Sakata Y, Salinger MH, Feldman T. Successful closure of a giant true saphenous vein graft aneurysm using the Amplatzer vascular plug. Catheter Cardiovasc Interv. 2006 Apr. 67(4):611-6. [Medline].

  13. Mehilli J, Pache J, Abdel-Wahab M, et al. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet. 2011 Sep 17. 378(9796):1071-8. [Medline].

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CT scan demonstrating a saphenous vein graft aneurysm.
Cardiac catheterization demonstrating a saphenous vein graft aneurysm.
Aortogram demonstrating a saphenous vein graft aneurysm.
This CT scan reveals a saphenous vein graft aneurysm.
Angiogram of a saphenous vein graft to the distal right coronary artery demonstrating a large aneurysm in the mid portion of the graft. Video courtesy of John S. Douglas, MD.
Final angiogram demonstrating coils within the aneurysm, and almost complete cessation of flow from the parent vessel into the aneurysm. Video courtesy of John S. Douglas, MD.
Another view demonstrating the saphenous vein graft aneurysm. Video courtesy of John S. Douglas, MD.
The first of many coils being deployed in the aneurysm. Video courtesy of John S. Douglas, MD.
 
 
 
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