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Saphenous Vein Graft Aneurysms Workup

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

Laboratory Studies

Evaluate for cardiac ischemia with serum biomarkers (creatine kinase and troponin).

Evaluate the patient's overall medical status, including renal and hepatic function.

Use electrocardiography (ECG) to evaluate for cardiac ischemia or infarction.

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Imaging Studies

A chest radiograph may suggest a saphenous vein graft aneurysm (SVGA) by revealing abnormalities of the mediastinum or other thoracic structures.

Multiple modalities have been used to confirm the diagnosis of SVGA, including computed tomography (CT) scanning, aortography, transesophageal echocardiography, transthoracic echocardiography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), cardiac catheterization, intravascular ultrasonography, and radionuclide ventriculography.

Note the following:

  • A CT scan of the chest shows the aneurysm as an enhancing mass in the mediastinum. CT, particularly high resolution studies such as 64-slice multidetector CT gated to the cardiac cycle, provides several useful pieces of information, including determining continuity of the mass with the SVG, determining the presence of thrombus, differentiating between solid and cystic masses, and mass effect on adjacent structures. See the image below.
    CT scan demonstrating a saphenous vein graft aneurCT scan demonstrating a saphenous vein graft aneurysm.
  • Coronary angiography is the criterion standard to delineate the anatomy of the aneurysm. A limitation of coronary angiography is impaired opacification of the SVGA if thrombus is present within the aneurysm. See the images below.
    Cardiac catheterization demonstrating a saphenous Cardiac catheterization demonstrating a saphenous vein graft aneurysm.
    Aortogram demonstrating a saphenous vein graft aneAortogram demonstrating a saphenous vein graft aneurysm.
  • Sherry and Harms described the ability of MRI to demonstrate the anatomy of the aneurysm and to assess the patency of the graft.[3]
  • Khabeishvili and associates demonstrated that transesophageal echocardiography can assist in diagnosing an SVGA.[4]
  • Benari and associates demonstrated that SVGAs can be correctly identified with first-pass radionuclide ventriculography.[5]
  • Ennis and associates have diagnosed SVGAs with intravascular ultrasonography.[6]

See the videos below for more information on SVGAs.

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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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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