Saphenous Vein Graft Aneurysms Workup

  • Author: Jesse P Jorgensen, MD; Chief Editor: Eric H Yang, MD   more...
 
Updated: Oct 4, 2011
 

Laboratory Studies

  • Evaluating for cardiac ischemia with serum biomarkers (creatine kinase and troponin)
  • Evaluating the patient's overall medical status, including renal and hepatic function
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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.
    • 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.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.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.[2]
    • Khabeishvili and associates demonstrated that transesophageal echocardiography can assist in diagnosing an SVGA.[3]
    • Benari and associates demonstrated that SVGAs can be correctly identified with first-pass radionuclide ventriculography.[4]
    • Ennis and associates have diagnosed SVGAs with intravascular ultrasonography.[5]

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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Other Tests

  • ECG to evaluate for cardiac ischemia or infarction
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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 and American Heart Association

Disclosure: Nothing to disclose.

Coauthor(s)

Tarek Helmy, MD, FACC  Assistant Professor of Clinical Medicine, Division of Cardiovascular Diseases, University of Cincinnati School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig T Basson, MD, PhD  Gladys and Roland Harriman Professor of Medicine, Director of the Center for Molecular Cardiology, Director of Cardiovascular Research, Division of Cardiology, Department of Medicine, Weill Cornell Medical College; Attending Physician, New York Presbyterian Hospital

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

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

Disclosure: Nothing to disclose.

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD  Associate Professor of Medicine, Director of Interventional Cardiology Fellowship Program, Henry Ford Hospital

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

Disclosure: Nothing to disclose.

Additional Contributors

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

References

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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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