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Giant venous aneurysm jeopardising internal mammary arterial graft patency

Olivier Van Caenegem1, Jean-Benoit le Polain de Waroux, Laurent de Kerchove

  • 1Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Belgium. olivier.vancaenegem@uclouvain.be

Interactive Cardiovascular and Thoracic Surgery
|June 23, 2012
PubMed

Insights

A rare giant aneurysm in a vein bypass graft compressed a crucial artery, causing heart failure. Surgical removal resolved the issue, highlighting a unique complication of coronary artery bypass surgery.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Imaging

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure.
  • Saphenous vein grafts (SVGs) are frequently used but can develop complications.
  • Giant aneurysms of venous bypass grafts are exceptionally rare.

Observation:

  • A 79-year-old male presented with acute heart failure and elevated troponin levels post-CABG.
  • Coronarography revealed a giant SVG aneurysm compressing the left internal mammary artery (LIMA) graft.
  • Cardiac CT confirmed the aneurysm's extrinsic compression of the LIMA graft, causing functional occlusion and myocardial ischemia.

Findings:

  • The giant SVG aneurysm was the direct cause of LIMA graft compression and subsequent myocardial ischemia.
  • This led to acute heart failure, evidenced by hypoperfusion on cardiac CT.
  • Surgical excision of the aneurysm was successfully performed without complications.

Implications:

  • This case represents the first documented instance of a giant SVG aneurysm causing LIMA compression and severe myocardial ischemia.
  • It underscores the potential for rare but serious complications associated with venous bypass grafts.
  • Highlights the importance of advanced imaging in diagnosing complex graft-related issues and the efficacy of surgical intervention.

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