Saphenous vein graft pseudoaneurysm: a case for medical management

Saphenous vein bypass pseudoaneurysm is rare but fatal complication after coronary bypass surgery. Pseudoaneurysm is managed either with a surgical or percutaneous approach. This patient underwent quadruple coronary artery bypass grafting 10 years earlier and was referred for recurrence of angina. Coronary and graft angiography revealed a pseudoaneurysm in the saphenous vein graft supplying the intermediate coronary artery. After discussion with the cardiothoracic surgeons, the patient was managed conservatively. He was continued on Aspirin, beta-blockers, statins, nitrates and angiotensin converting enzyme inhibitors. He was followed-up regularly in outpatient clinic with a planned repeat coronary and graft angiography. The patient's symptoms remain stable and repeat angiography 24 months later did not show any significant deterioration of the graft pseudoaneurysm. He remains stable at 12 months after the repeated angiography.