Saphenous Vein Graft Aneurysm:
Clinical:
Saphenous vein graft aneurysms are a rare complication that can occur at any time following coronary artery bypass grafting (CABG). Postulated etiologies include progressive atherosclerotic disease within the graft, weakness at branch points or valves, and imperfect surgical technique. Most patients are asymptomatic, but they may present with myocardial ischemia due to emboli arising from thrombus within the aneuysm. Pseudoaneuysms usually occur at the proximal or distal ends of the graft, while true aneursyms occur in the body of the graft. True aneurysms are less common than pseudoaneurysms. Treatment includes resection and revascularization.X-ray:
CXR: On plain films, if large enough, saphenous vein graft aneurysms and pseudoaneurysms appear as paracardiac, hilar, or mediastinal masses.Computed tomography: On CT, the lesions are enhancing tubular mixed attenuation masses along the mediastinal or cardiac border. Low density identified along the periphery of the aneurysm represents thrombus.
REFERENCES:
(1) AJR 1997; Chest case of the day. Rupture of a sinus of Valsalva aneurysm into the right ventricle. 168: 747-749 (no abstract available)
(2) AJR 2008; Takaki MTT, et al. Nonatherosclerotic cardiovascular findings on MDCT coronary angiography: a selection of abnormalities. 190: 934-946
