Giant saphenous vein graft aneurysm and associated constrictive pericarditis in a patient with prior CABG

Saphenous vein graft aneurysms (SVGA) are a rare but significant complication following coronary artery bypass grafting. They can lead to life-threatening conditions including rupture, fistula formation, and compression of adjacent thoracic structures. Current consensus calls for intervention, either surgically or percutaneously, with no agreed upon threshold for observation measures only. This case describes the clinical course of a patient with a known SVGA a decade prior to their current presentation with constrictive pericarditis.

The patient developed a large SVGA after undergoing coronary artery bypass grafting. The SVGA was monitored for over a decade without intervention. The patient then developed worsening symptoms of volume overload and was found to have developed a constrictive left-sided pericarditis due to the SVGA compressing left-ventricular inflow. Two pericardiectomies were performed, with debridement of the SVGA and excision of calcified pericardial plaques. Although the constriction was addressed, the patient was unable to recover and ultimately died.

This report characterizes an SVGA causing constrictive pericarditis following coronary artery bypass grafting. This case demonstrates the need for appropriate and timely intervention in managing vein graft aneurysms and preventing fatal complications. We recommend annual echocardiography with dedicated evaluation for constriction to guide the need for intervention in patients with SVGA.