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Large saphenous vein graft aneurysm with a fistula to the right atrium

Tsutomu Sugimoto1, Kazuo Yamamoto, Shinpei Yoshii

  • 1Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|January 18, 2007
PubMed

Insights

A 65-year-old man experienced chest pain due to aneurysmal coronary artery bypass grafts (CABG) and a right atrial fistula. Surgical repair involved graft excision, fistula closure, and new bypass grafts.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
  • Saphenous vein grafts (SVGs) are frequently used but can develop complications over time.
  • Aneurysmal degeneration and arteriovenous fistula formation are rare but serious SVG complications.

Observation:

  • A 65-year-old male presented with exertional anterior chest pain.
  • Previous CABG surgery 20 years prior involved SVGs to the left anterior descending (LAD) and right coronary artery (RCA).
  • Angiography revealed significant aneurysmal dilation in both SVGs and an unusual fistula between the right SVG and the right atrium (RA).

Findings:

  • Surgical excision of the aneurysmal SVG segments was performed.
  • The right atrial fistula was successfully closed using the atrial wall.
  • Revascularization was achieved with new bypass grafts using the left internal thoracic artery (LITA) and the gastroepiploic artery (GEA).

Implications:

  • This case highlights the potential for late-onset, complex complications following CABG with SVGs.
  • Prompt diagnosis and surgical intervention are crucial for managing SVG aneurysms and fistulas.
  • Successful surgical management can restore coronary perfusion and improve patient outcomes.

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