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]}

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]

Differential Diagnoses

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Media Gallery

Saphenous Vein Graft Aneurysms. Computed tomography scan demonstrating a saphenous vein graft aneurysm.
Saphenous Vein Graft Aneurysms. Cardiac catheterization demonstrating a saphenous vein graft aneurysm.
Saphenous Vein Graft Aneurysms. Aortogram demonstrating a saphenous vein graft aneurysm.
Saphenous Vein Graft Aneurysms. This computed tomography scan reveals a saphenous vein graft aneurysm.
Saphenous Vein Graft Aneurysms. 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.
Saphenous Vein Graft Aneurysms. 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.
Saphenous Vein Graft Aneurysms. Another view demonstrating the saphenous vein graft aneurysm. Video courtesy of John S. Douglas, MD.
Saphenous Vein Graft Aneurysms. The first of many coils being deployed in the aneurysm. Video courtesy of John S. Douglas, MD.

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Author

Jesse P Jorgensen, MD Clinical Assistant Professor of Cardiology, University of South Carolina School of Medicine, Greenville; Medical Director, Cardiac Catheterization Laboratory, Lead Physician, Transcatheter Aortic Valve Replacement Program, Greenville Health System; Partner, Carolina Cardiology Consultants

Jesse P Jorgensen, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Coauthor(s)

Paul Timothy Maddux, MD Chief Resident Physician, Junior Faculty, Department of Internal Medicine, University of South Carolina-Greenville Health System

Paul Timothy Maddux, MD is a member of the following medical societies: American College of Physicians, American Medical 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.

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.

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.

Saphenous Vein Graft Aneurysms Clinical Presentation

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