Saphenous Vein Graft Aneurysms Workup

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

Laboratory Studies

Patients suspected to have a saphenous vein graft aneurysm (SVGA) should be evaluated for cardiac ischemia with serum biomarkers (creatinine kinase and troponin). The patient’s overall medical status should be considered, including their renal and hepatic function. Electrocardiography (ECG) should be utilized to evaluate for cardiac ischemia or infarction.

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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. Case reports seem to favor cardiac computed tomography (CT) angiography (CTA) for establishing the diagnosis, treatment planning, and posttreatment evaluation. [10]  Other diagnostic tools include aortography, transesophageal echocardiography, transthoracic echocardiography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), cardiac catheterization, and intravascular ultrasonography.

CT scanning of the chest shows an SVGA as an enhancing mass in the mediastinum. CT scanning, particularly high-resolution studies gated to the cardiac cycle, provides useful information, including determining the continuity of the mass with the saphenous vein graft (SVG), determining the presence of thrombi, differentiating between solid and cystic masses, and the mass effect on adjacent structures. See the image below

Saphenous Vein Graft Aneurysms. Computed tomograph Saphenous Vein Graft Aneurysms. Computed tomography scan demonstrating a saphenous vein graft aneurysm.

Coronary angiography is the criterion standard to delineate the anatomy of the aneurysm. However, a limitation of coronary angiography is impaired opacification of the SVGA if a thrombus is present within the aneurysm. See the following image.

Saphenous Vein Graft Aneurysms. Cardiac catheteriz Saphenous Vein Graft Aneurysms. Cardiac catheterization 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. [22]  Khabeishvili and associates demonstrated that transesophageal echocardiography (TEE) can also assist in diagnosing an SVGA. [23]  Benari et al revealed that SVGAs can be correctly identified with first-pass radionuclide ventriculography. [24]  Ennis and colleagues have diagnosed SVGAs with intravascular ultrasonography. [25]

See the videos below for more information on SVGAs.

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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