Mycotic Ascending Aortic Pseudoaneurysm With Radial Artery Graft Failure Following Coronary Artery Bypass Surgery

Pseudoaneurysm of the ascending aorta is a rare but potentially fatal complication post cardiac surgery, often linked to infection.

A 59-year-old woman presented 4 months post coronary artery bypass graft surgery with fatigue, fever, and acute coronary syndrome. Urgent computed tomography revealed a 31-mm anterior pseudoaneurysm at the occluded radial artery graft origin, with perianeurysmal inflammation and sternal osteomyelitis. She underwent urgent resection and bovine pericardial patch repair, followed by 6 weeks of intravenous antibiotics.

Post-coronary artery bypass graft aortic pseudoaneurysms typically arise at graft or cannulation sites and may be mycotic. This case highlights a rare mechanism in which proximal anastomotic disruption caused early radial artery graft failure resulting in acute coronary syndrome. Allografts or bovine conduits are preferred for repair to minimize the risk of recurrent infection.

Mycotic pseudoaneurysm should be suspected in patients with unexplained symptoms after cardiac surgery. Computed tomography plays a vital role in diagnosis, infection extent, surgical planning, and postoperative surveillance of recurrence.