Successful closure of a giant true saphenous vein graft aneurysm using the Amplatzer vascular plug

An 85-year-old man was found to have a 9 cm diameter true aneurysm of an obtuse marginal saphenous vein graft. The graft was fed by a relatively narrow neck from the proximal remnant of the obtuse marginal graft 10 years after prior coronary artery bypass graft surgery. An Amplatzer vascular plug was used successfully to occlude the neck of the aneurysm. Follow-up CT scan 1 month afterward demonstrated retained contrast in the aneurysm, demonstrating complete occlusion between the aorta and aneurysm sac. Pressure recordings from within the aneurysm sac suggest bidirectional flow in the neck as the mechanism for the maintained patency of the aneurysm. The use of a vascular plug is an effective method for aneurysm occlusion when the anatomy is suitable.