Coronary artery bypass graft pseudoaneurysm from saphenous vein graft stent fracture

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Surgery

Background:

• Saphenous venous graft (SVG) pseudoaneurysms are infrequent but serious complications following coronary artery bypass grafting (CABG).
• Stent fracture within a venous graft can present a unique and challenging etiology for pseudoaneurysm formation.
• These pseudoaneurysms pose a significant risk of rupture if not adequately managed.

Observation:

• An 85-year-old male with a history of CABG presented with dyspnea, revealing a large, partially thrombosed pseudoaneurysm at the distal SVG with associated stent fracture on CT.
• Initial endoluminal exclusion using a covered stent was attempted but resulted in persistent pseudoaneurysm filling and enlargement on follow-up imaging.
• The patient exhibited moderate depression of left ventricular ejection fraction post-intervention.

Findings:

• Coil embolization of the SVG proximal to the pseudoaneurysm was performed to mitigate the risk of rupture.
• Despite the pseudoaneurysm's persistence and enlargement after the initial intervention, the subsequent embolization procedure allowed for patient stabilization.
• The patient remained hemodynamically stable and was discharged following the management of the SVG pseudoaneurysm.

Implications:

• SVG pseudoaneurysms, particularly those linked to stent fracture, necessitate prompt recognition and management due to their rupture potential.
• Covered stents offer a viable endovascular treatment option for SVG pseudoaneurysms, especially in patients unsuitable for open surgery.
• Proximal embolization serves as a crucial adjunctive or alternative strategy to reduce rupture risk in complex SVG pseudoaneurysm cases, even when initial endovascular exclusion is incomplete.