Diagnostic Considerations
Important considerations
Patients who have had coronary artery revascularization with vein grafts and present with angina or infarction should have a thorough cardiac workup to exclude recurrent disease or aneurysm development.
The diagnosis of saphenous vein graft aneurysm (SVGA) requires a high index of suspicion and may require multiple imaging modalities for the diagnosis to be made.
During surgery, care must be taken to avoid manipulation of the aneurysm, as this may dislodge thrombus and result in distal embolization.
Biopsy of a mediastinal mass without knowledge that it represents an SVGA could be catastrophic.
Other problems to be considered
Other conditions to consider in the differential diagnosis of patients with suspected SVGA include lymphoma and pericardial cyst.
Differential Diagnoses
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Aortic Dissection
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Atherosclerosis
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Benign Lung Tumors
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CT scan demonstrating a saphenous vein graft aneurysm.
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Cardiac catheterization demonstrating a saphenous vein graft aneurysm.
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Aortogram demonstrating a saphenous vein graft aneurysm.
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This CT scan reveals a saphenous vein graft aneurysm.
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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.
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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.
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Another view demonstrating the saphenous vein graft aneurysm. Video courtesy of John S. Douglas, MD.
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The first of many coils being deployed in the aneurysm. Video courtesy of John S. Douglas, MD.
