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Non-ST-Segment Myocardial Infarction Resulting From Thrombotic Saphenous Vein Graft Aneurysm

Nicholas L Biondi1,2, Ahmed Nour3, Bryan J Fiema1

  • 1Adult Cardiology, Arnot Ogden Medical Center, Elmira, USA.

Cureus
|May 5, 2021
PubMed

Insights

Embolism from saphenous vein graft (SVG) aneurysms can cause acute coronary syndromes. This case highlights thrombus embolism from an SVG aneurysm leading to myocardial infarction.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Acute coronary syndromes (ACS) are typically caused by intracoronary thrombus formation.
  • Coronary emboli are a rare cause of ACS, with documented cases often involving native coronary arteries or prosthetic material.
  • Saphenous vein grafts (SVG) are commonly used conduits in coronary artery bypass grafting (CABG) surgery.

Observation:

  • Saphenous vein grafts are susceptible to atherosclerosis, leading to occlusion and aneurysmal changes.
  • Aneurysmal dilation in SVG conduits can create areas of stagnant blood flow.
  • These stagnant areas may serve as a nidus for thrombus formation with embolic potential.

Findings:

  • This case report describes a patient presenting with non-ST-segment myocardial infarction (NSTEMI).
  • The NSTEMI was suspected to be secondary to embolization of a thrombus originating from an SVG aneurysm.
  • This represents a rare but significant complication of SVG use in CABG patients.

Implications:

  • Highlights a previously under-described mechanism of ACS in patients with CABG.
  • Suggests the need for vigilance regarding SVG aneurysm complications, including thrombus formation and embolism.
  • May inform diagnostic and therapeutic strategies for patients with suspected SVG-related myocardial infarction.

Keywords:
acute coronary syndromeadult cardiologycoronary artery bypass grafting (cabg)general internal medicinegreat saphenous veinnon-st-segment elevation myocardial infarction (nstemi)

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