Giant aneurysm of an aortocoronary venous bypass graft treated by an endovascular approach

Aneurysmal transformation of a venous coronary bypass graft is a rare (incidence of 0.07%), yet potentially fatal complication of coronary artery bypass grafting. It is postulated > 5 years following coronary artery bypass graft (CABG) multiple factors contribute to the development of graft aneurysm, including atherosclerosis, endothelial dysfunction, changes in smooth muscle orientation in the proximity of valves [1] and trauma during surgical handling of the vein [2]. Establishing the final diagnosis is hampered by unspecific clinical presentation (chest pain, dyspnea), with nearly 1/3 of cases being diagnosed incidentally [1]. In consequence, patients undergo extensive and time-consuming cardiological workup prior to treatment. Despite cardiac surgery remaining the mainstay of treatment for coronary bypass graft aneurysms, minimally invasive endovascular procedures constitute an accepted and effective alternative for patients with multiple comorbidities without mechanical complications [1–3].
We hereby present a unique case of a 71-year-old patient with a giant aneurysmal transformation of an SVG-OM graft resulting in worsening dyspnea due to pulmonary trunk compression, successfully treated by endovascular embolization.
A patient with an implantable cardioverter-defibrillator and a past history of multiple coronary arterial bypass grafting (Ao-DIAG-LAD, Ao-RCA, SVG-OM, LITA-LAD) and angioplasty of the Ao-DIAG-LAD graft was admitted due to worsening dyspnea. Coronary computed tomography (CT) angiography revealed the presence of a partially thrombosed SVG-OM bypass graft aneurysm, measuring 73 × 66 × 61 mm and causing pulmonary trunk narrowing to 11 mm in the anteroposterior (AP) view (Figure 1 A); another fully thrombosed, smaller aneurysm was visible at the occluded distal segment of the graft. A third aneurysm was detected at the proximal Ao-DIAG-LAD graft; full patency of the previously stented graft with no filling of the aneurysm was observed. Although patients with mechanical complications of coronary graft aneurysms, e.g. compression of adjacent vascular structures, are routinely treated by classic cardiac surgery [1], it was decided to refer our patient for less invasive endovascular exclusion of the partially filling SVG-OM graft aneurysm due to extensive post-operative retrosternal fibrosis and signs of cardiac insufficiency (ejection fraction (EF) = 28%). Based on distal graft impatency and severe compression symptoms,...


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