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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Exclusion of a giant saphenous vein graft pseudo-aneurysm with a "double-layer bridging" technique
Alberto Boi1, Francesco Sanna1, Angelica Rossi1
1Azienda Ospedaliera Brotzu, Interventional Cardiology, Cagliari, Sardegna, Italy.
Insights
A novel "double-layer bridging" technique effectively treats severe saphenous vein graft aneurysms, a dangerous complication after coronary artery bypass surgery, offering a safe percutaneous alternative.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for coronary artery disease.
- Saphenous vein grafts (SVGs) are frequently used but are prone to dilatation and aneurysm formation over time.
- Severe SVG dilatation poses significant mortality risks and traditionally requires surgical intervention.
Observation:
- A 72-year-old male presented with chest pain 23 years post-CABG.
- Contrast-enhanced CT revealed a severe, double-lobed dilatation of an SVG supplying the obtuse marginal branch.
- Coronary angiography showed significant turbulence within the dilated SVG, hindering complete opacification.
Findings:
- A new interventional technique, "double-layer bridging," was successfully employed.
- This technique combines a metallic drug-eluting stent (DES) and a covered stent in a double-layer configuration.
- The procedure effectively excluded the giant SVG aneurysm while maintaining distal blood flow.
Implications:
- The "double-layer bridging" technique offers a safe and feasible percutaneous option for managing severe SVG aneurysms.
- This approach is adaptable to various dilatation types and lengths, potentially reducing the need for open surgery.
- It represents a significant advancement in treating a high-mortality complication of CABG surgery.
Abstract:
We report the case of a 72-year-old man admitted to our hospital for chest pain. He had undergone coronary artery bypass graft surgery 23 years before. Contrast-enhanced computer tomography revealed a severe double-lobed dilatation of the saphenous vein graft for the obtuse marginal branch. Coronary angiography did not opacify completely the saphenous vein graft for the huge turbulence in the dilatation. Severe saphenous vein graft dilatation have a significant mortality and it has been generally treated by surgical repair, such as resection with or without bypass of the affected territory. We described an interventional technique, named "double-layer bridging" that combines metallic DES and covered stent used in a double layer. This percutaneous technique, relatively simple and virtually usable for any type of severe dilatation independently of length, can be a reasonable and safe option to exclude giant aneurysm and maintaining distal flow.
