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(Circulation. 2000;101:1075.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Saphenous Vein Graft Aneurysm

Linda Cadaret, MD; William Cotts, MD; Wayne Richenbacher, MD

From the Divisions of Cardiology and Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City.

Correspondence to Linda Cadaret, MD, Division of Cardiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, Iowa 52242-1091.

A58-year-old white woman who had undergone 3-vessel coronary artery bypass graft surgery in 1988 presented with a 5-month history of chest pressure at rest. At the time of her coronary artery bypass operation, the left internal mammary artery (LIMA) was used to graft the left anterior descending coronary artery (LAD). Separate saphenous vein grafts (SVGs) were placed to the obtuse marginal branch (OM) of the left circumflex (LCx) and posterior descending (PDA) coronary arteries.

A chest roentgenogram revealed a mass in the middle mediastinum near the left pulmonary artery (Figure 1). Computed tomography (CT) of the patient’s chest identified the mass as a 7x7x4-cm aneurysm of the SVG to the OM (Figure 2). The aneurysm contained swirling contrast and laminated thrombus. Also, the aneurysm compressed the left pulmonary artery. Coronary angiography revealed a right-dominant system with a normal left main coronary artery. There was an 80% stenosis of the mid LAD and total occlusion of the proximal LCx and right coronary arteries. There was a 70% stenosis of the SVG to the OM, with a mid/distal aneurysm containing thrombus. There was an 80% stenosis of the SVG to the PDA and severe diffuse disease of the LIMA.

View larger version (143K): [in this window] [in a new window]   Figure 1. Chest roentgenogram revealing middle mediastinal mass (arrows).

View larger version (95K): [in this window] [in a new window]   Figure 2. CT of patient’s chest. Vein graft aneurysm contains laminated thrombus and an eccentric, contrast-filled lumen (arrows).

At surgery, the LAD and PDA were bypassed with SVGs. The aneurysm of the SVG to the OM was resected (Figure 3). The . . . [Full Text of this Article]

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