Saphenous Vein Graft Aneurysms Clinical Presentation

Updated: Dec 15, 2020
  • Author: Jesse P Jorgensen, MD; Chief Editor: Eric H Yang, MD  more...
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Presentation

History

Saphenous vein graft aneurysm (SVGAs) are usually suspected after abnormalities are noted on chest radiographs. [6]  Most patients with true aneurysms (45-55%) are asymptomatic. According to reported cases, mean aneurysm size at diagnosis was 60.4 mm, with reports of pseudoaneurysms being even larger. Although aneurysm growth is commonly reported, rates of growth vary. [3]

Symptomatic patients with true aneurysms present with myocardial infarction (20-25%), unstable angina (15-20%), or congestive heart failure (5%). By contrast, most patients having 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.

The size of SVGAs and their proximity to intrathoracic structures causes a variety of mechanical complications that are well documented in the literature. Acute coronary syndrome and congestive heart failure are common findings associated with SVGA. More rare and/or severe complications include rupture, severe tricuspid stenosis, right atrial fistula formation, fistula formation leading to isolated right heart failure, cardiac compression and subsequent atrial flutter, pulmonary artery compression, high-gradient right ventricular outflow tract obstruction, and cardiac tamponade caused by a leaking SVGA. [13, 14, 15, 16, 17, 18, 19, 20]

 

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Physical Examination

The diagnosis of saphenous vein graft aneurysm (SVGA) is typically not suggested by physical examination. However, the literature has provided cases with a variety of findings includin: cutaneous bleeding or hemoptysis from fistula development to the skin or bronchial tree; palpable pulsatile anterior chest wall mass [13] ; a new murmur from fistula formation, abdominal pain from compression of upper abdominal organs [11] ; and stridor. [21]

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