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Use of multiple stents to seal off an epicardial pseudoaneurysm
Aamir Hameed1, Shafiq Hanna-Moussa, Shukri David
1Providence Hospital, Southfield, MI, USA.
Insights
A cardiac mass after coronary artery bypass graft surgery was diagnosed as a saphenous vein graft pseudoaneurysm. Stent closure successfully treated the pseudoaneurysm, preserving graft function.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for severe coronary artery disease.
- Saphenous vein grafts (SVGs) are frequently used conduits, but are susceptible to complications.
- Pseudoaneurysms are rare but serious complications that can arise at anastomosis sites.
Observation:
- A 69-year-old male developed a 6 cm cardiac mass three months post-triple vessel CABG.
- Echocardiogram and computed tomography (CT) scans confirmed a contrast-enhancing cardiac mass.
- Cardiac catheterization identified the mass as a pseudoaneurysm at the distal SVG anastomosis to the circumflex marginal branch.
Findings:
- The pseudoaneurysm neck was successfully sealed using three intravascular stents.
- The intervention resulted in a patent saphenous vein graft.
- Good distal run-off was maintained post-procedure, indicating successful revascularization.
Implications:
- Endovascular stent closure is a viable treatment option for SVG pseudoaneurysms.
- This minimally invasive approach can effectively manage graft complications post-CABG.
- Preserving graft patency is crucial for long-term patient outcomes after coronary revascularization.
Abstract:
A 69-year-old male patient had triple-vessel coronary artery bypass graft (CABG) surgery. Three months later, an echocardiogram revealed a 6 x 6 cm cardiac mass. A computed tomography scan of the chest showed a 6 cm mass with contrast enhancement. Cardiac catheterization revealed a pseudoaneurysm of the saphenous vein graft to a circumflex marginal branch at the distal anastomosis site. The aneurysm neck was completely sealed off using 3 stents, leaving a patent saphenous vein graft and good distal run-off.