Sections

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.

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 tomography scan demonstrating a saphenous vein graft aneurysm.

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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 catheterization demonstrating a saphenous vein graft aneurysm.

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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.

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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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Treatment & Management

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Sareyyupoglu B, Schaff HV, Ucar I, Sundt TM 3rd, Dearani JA, Park SJ. Surgical treatment of saphenous vein graft aneurysms after coronary artery revascularization. Ann Thorac Surg. 2009 Dec. 88 (6):1801-5. [QxMD MEDLINE Link].
Ramirez FD, Hibbert B, Simard T, Pourdjabbar A, Wilson KR, Hibbert R, et al. Natural history and management of aortocoronary saphenous vein graft aneurysms: a systematic review of published cases. Circulation. 2012 Oct 30. 126 (18):2248-56. [QxMD MEDLINE Link].
Topaz O, Rutherford MS, Mackey-Bojack S, Prinz AW, Katta S, Salter D, et al. Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. Cardiovasc Pathol. 2005 Nov-Dec. 14 (6):298-302. [QxMD MEDLINE Link].
Bourassa MG, Enjalbert M, Campeau L, Lesperance J. Progression of atherosclerosis in coronary arteries and bypass grafts: ten years later. Am J Cardiol. 1984 Jun 15. 53 (12):102C-107C. [QxMD MEDLINE Link].
Le Breton H, Pavin D, Langanay T, Roland Y, Leclercq C, Beliard JM, et al. Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts. Heart. 1998 May. 79 (5):505-8. [QxMD MEDLINE Link].
Omer MA, Laster SB, Amin A, Main ML. Contrast-Enhanced Echocardiographic Evaluation of a Giant Saphenous Vein Graft Aneurysm. Echocardiography. 2016 Jul. 33 (7):1092-1094. [QxMD MEDLINE Link].
Neitzel GF, Barboriak JJ, Pintar K, Qureshi I. Atherosclerosis in aortocoronary bypass grafts. Morphologic study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis. 1986 Nov-Dec. 6 (6):594-600. [QxMD MEDLINE Link].
Dieter RS, Patel AK, Yandow D, Pacanowski JP Jr, Bhattacharya A, Gimelli G, et al. Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series. Cardiovasc Surg. 2003 Dec. 11 (6):507-13. [QxMD MEDLINE Link].
Fohlen A, Tager P, Lognoné T, Pelage JP. Acute chest pain with elevated troponin due to rupture of previously stented saphenous vein graft aneurysm. Diagn Interv Imaging. 2016 Nov. 97 (11):1183-1185. [QxMD MEDLINE Link].
Baydoun A, Sabeh MK, Abdul Rahman R, Park SJ, Parikh SA. Saphenous vein graft aneurysm presenting as abdominal pain. Am J Cardiol. 2015 Jun 1. 115 (11):1619-20. [QxMD MEDLINE Link].
Almanaseer Y, Rosman HS, Kazmouz G, Giraldo AA, Martin J. Severe dilatation of saphenous vein grafts: a late complication of coronary surgery in which the diagnosis is suggested by chest x-ray. Cardiology. 2005. 104 (3):150-5. [QxMD MEDLINE Link].
Steele D, Viviano A, Bilkhu R, Diab M, Bogle R, Sharma V, et al. Gigantic Saphenous Vein Graft Aneurysm Presenting as Pulsatile Anterior Chest Wall Mass. Ann Thorac Surg. 2016 Sep. 102 (3):e263. [QxMD MEDLINE Link].
Jellis CL, Navia JL, Flamm SD, Rodriguez LL. Severe Functional Tricuspid Stenosis Secondary to a Giant Saphenous Vein Bypass Graft Aneurysm. Circulation. 2016 May 24. 133 (21):2099-102. [QxMD MEDLINE Link].
Moschonas K, Patterson T, Rajani R, Young C. A rare case of a giant saphenous vein graft aneurysm with right atrial fistula formation. BMJ Case Rep. 2016 Feb 22. 2016:[QxMD MEDLINE Link].
Boon KJ, Arshad MA, Singh H, Lainchbury JG, Blake JW. Saphenous vein graft aneurysm fistula formation causing right heart failure: an unusual presentation. Intern Med J. 2015 Nov. 45 (11):1185-9. [QxMD MEDLINE Link].
Gutman SJ, Gutman J, Vrazas J, Berman DS. Saphenous vein graft aneurysm causing pulmonary artery compression with exercise. Circulation. 2015 Oct 27. 132 (17):1681-2. [QxMD MEDLINE Link].
Rier JD, Schoepf UJ, Renker M, Baumann S, Powers ER. Aortocoronary saphenous vein graft aneurysm causing high-gradient right ventricular outflow tract obstruction. Eur Heart J Cardiovasc Imaging. 2015 Jan. 16 (1):117. [QxMD MEDLINE Link].
Krishnasamy P, Gillespie JS, McGlinchey PG, Khan MM, Adgey AA. Giant true saphenous vein graft aneurysm causing cardiac compression: a rare cause of atrial flutter. Int J Cardiol. 2007 Oct 18. 121 (3):317-9. [QxMD MEDLINE Link].
Kang G, Shepherd J, Ferraro R, Butler M, Petrella R. Cardiac tamponade caused by a leaking coronary saphenous vein graft aneurysm. Am J Emerg Med. 2007 Sep. 25 (7):858.e1-2. [QxMD MEDLINE Link].
Parviz Y, Parker W, Brown P, West JN. Giant saphenous vein graft aneurysm presenting as stridor. Eur Heart J Cardiovasc Imaging. 2014 Jun. 15 (6):679. [QxMD MEDLINE Link].
Sherry CS, Harms SE. MR imaging of pseudoaneurysms in aortocoronary bypass graft. J Comput Assist Tomogr. 1989 May-Jun. 13 (3):426-9. [QxMD MEDLINE Link].
Khabeishvili G, Shaburishvili T, Wann S, Sampson C, Manley JC. Saphenous vein graft pseudoaneurysm: diagnosis by transesophageal echocardiography and magnetic resonance imaging. J Am Soc Echocardiogr. 1995 May-Jun. 8 (3):338-40. [QxMD MEDLINE Link].
Benari B, Erel J, Allen HN, Friedman J, Kiat H, Silverman JM, et al. Aneurysm of saphenous vein bypass graft detected by first-pass radionuclide ventriculography. Am Heart J. 1997 Jan. 133 (1):133-6. [QxMD MEDLINE Link].
Ennis BM, Zientek DM, Ruggie NT, Billhardt RA, Klein LW. Characterization of a saphenous vein graft aneurysm by intravascular ultrasound and computerized three-dimensional reconstruction. Cathet Cardiovasc Diagn. 1993 Apr. 28 (4):328-31. [QxMD MEDLINE Link].
Memon AQ, Huang RI, Marcus F, Xavier L, Alpert J. Saphenous vein graft aneurysm: case report and review. Cardiol Rev. 2003 Jan-Feb. 11 (1):26-34. [QxMD MEDLINE Link].
Rezq A, Politi L, Sangiorgi G. Long-term outcome of percutaneous exclusion of huge saphenous vein graft aneurysms using peripheral covered-stents as alternative to surgical repair. J Invasive Cardiol. 2012 Dec. 24 (12):689-91. [QxMD MEDLINE Link].
Khan A, Brienesse S, Boyle A, Collins N. Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations. Catheter Cardiovasc Interv. 2019 Apr 1. 93 (5):927-32. [QxMD MEDLINE Link].
Bosmans JM, Claeys MJ, Dilling D, Vrints CJ. Unsuccessful long-term outcome after treatment of a vein graft false aneurysm with a polytetrafluoethylene-coated Jostent. Catheter Cardiovasc Interv. 2000 May. 50 (1):105-8. [QxMD MEDLINE Link].
Brilakis ES, Lichtenwalter C, de Lemos JA, Roesle M, Obel O, Haagen D, et al. A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial. J Am Coll Cardiol. 2009 Mar 17. 53 (11):919-28. [QxMD MEDLINE Link].
Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, et al. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet. 2011 Sep 17. 378 (9796):1071-8. [QxMD MEDLINE Link].
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Skripochnik E, Ford B, Bilfinger TV, Weinstein JB, Tassiopoulos AK, Loh SA. Endovascular repair of the ascending aorta for an anastomotic saphenous vein graft aneurysm. Ann Vasc Surg. 2020 Apr. 64:412.e1-.e5. [QxMD MEDLINE Link].
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Mehta N, Satler L, Waksman R, Ben-Dor I. Percutaneous management of a saphenous vein graft aneurysm with GraftMaster covered stents. Cardiovasc Revasc Med. 2020 Sep 16. [QxMD MEDLINE Link].

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 Workup

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