Saphenous Vein Graft Aneurysms Clinical Presentation

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

History

Most patients with true aneurysms (45-55%) are asymptomatic and present incidentally with a hilar or mediastinal mass on chest radiograph or other imaging modality. Several cases of saphenous vein graft aneurysm (SVGA) that mimic a cardiac mass on echocardiography have been described. Symptomatic patients present with acute coronary syndrome with myocardial infarction (20-25%), unstable angina (15-20%), or congestive heart failure (5%). Compression of surrounding structures may occur; recently, cardiac tamponade from right atrial compression and cardiac ischemia from compression of an adjacent left internal mammary artery bypass graft have been reported.

By contrast, most patients with false aneurysm present with symptoms, including unstable angina (45-50%), myocardial infarction (15%), bleeding (10%), hemoptysis (6%), and infection (4%). Only 15% of patients with false SVGA are asymptomatic.

Note the following:

  • The sudden onset of chest pain in a patient with SVGA may represent abrupt fistula formation with coronary steal.
  • Hemoptysis may occur because of bleeding from the SVGA into lung parenchyma or from fistula formation between the SVGA and a bronchus.
  • The triad of chest pain, mediastinal mass, and previous coronary bypass surgery has been suggested to raise suspicion for SVGA.
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Physical

The diagnosis of SVGA is typically not suggested by physical examination. However, the following signs may be uncovered:

  • Cutaneous bleeding or hemoptysis from fistula development to either the skin or bronchial tree
  • Palpable pulsatile mass
  • A new murmur (from fistula formation)
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Causes

Authorities have identified a number of disorders in individuals with SVGAs. However, whether the following disorders represent random associations, secondary associations, or true causal factors of SVGAs remains unknown:

  • Previous aneurysms
  • Postoperative mediastinitis prior to aneurysm development
  • Hypertension
  • In one small series, 15% of SVGAs were mycotic and 5% were associated with torn sutures.
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