Saphenous Vein Graft Aneurysms Workup

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

Laboratory Studies

Evaluate for cardiac ischemia with serum biomarkers (creatine kinase and troponin).

Evaluate the patient's overall medical status, including renal and hepatic function.

Use electrocardiography (ECG) to evaluate for cardiac ischemia or infarction.

Next:

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, including computed tomography (CT) scanning, aortography, transesophageal echocardiography, transthoracic echocardiography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), cardiac catheterization, intravascular ultrasonography, and radionuclide ventriculography.

Note the following:

  • A CT scan of the chest shows the aneurysm as an enhancing mass in the mediastinum. CT, particularly high resolution studies such as 64-slice multidetector CT gated to the cardiac cycle, provides several useful pieces of information, including determining continuity of the mass with the SVG, determining the presence of thrombus, differentiating between solid and cystic masses, and mass effect on adjacent structures. See the image below.

    CT scan demonstrating a saphenous vein graft aneur CT scan demonstrating a saphenous vein graft aneurysm.
  • Coronary angiography is the criterion standard to delineate the anatomy of the aneurysm. A limitation of coronary angiography is impaired opacification of the SVGA if thrombus is present within the aneurysm. See the images below.

    Cardiac catheterization demonstrating a saphenous Cardiac catheterization demonstrating a saphenous vein graft aneurysm.
    Aortogram demonstrating a saphenous vein graft ane Aortogram 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. [3]

  • Khabeishvili and associates demonstrated that transesophageal echocardiography can assist in diagnosing an SVGA. [4]

  • Benari and associates demonstrated that SVGAs can be correctly identified with first-pass radionuclide ventriculography. [5]

  • Ennis and associates have diagnosed SVGAs with intravascular ultrasonography. [6]

See the videos below for more information on SVGAs.

Another view demonstrating the saphenous vein graft aneurysm. Video courtesy of John S. Douglas, MD.
The first of many coils being deployed in the aneurysm. Video courtesy of John S. Douglas, MD.
Previous