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Compression of Main Pulmonary Artery by Giant Saphenous Vein Graft Aneurysm David Austin, MD, MRCP, Sanjay Asopa, PhD, MRCS, W. Andrew Owens, MD, FRCS (CTh), and Jim A. Hall, MA, MD Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, United Kingdom A n aneurysm of a saphenous vein graft (SVGA) is a rare late complication of coronary artery bypass grafting (CABG). We present a case of a 75-year-old retired family physician who underwent CABG in 1984 and 1991. At the second procedure, all previous grafts were tied off and de novo aortocoronary reverse SVG grafts were placed to the posterior descending coronary artery, obtuse marginal artery (OM), and left anterior descending coronary artery (LAD). The patient represented 19 years after his second CABG with a non-ST elevation myocardial infarction, and recent history of exer- tional dyspnea. A chest roentgenogram ( Fig 1) revealed a left hilar mass. Computed tomographic scan ( Fig 2A) and recon- structed computed tomographic coronary angiogram ( Fig 2B) show an SVG aneurysm, believed to have arisen from the OM graft (measuring 8 cm in diameter) compressing the main pulmonary artery (MPA). In view of the aneurysm size, relationship to the main pulmonary artery, and recent symptomatic status, surgical management was recommended. Standard invasive coronary angiography showed severe native disease, patent SVG to the right coronary artery, a recently occluded SVG to the LAD graft, and delineated the SVGA arising from the OM graft, which had little antegrade flow. At operation, femoral-femoral bypass was established, and a false SVGA was found arising from the distal anastamosis site of the OM graft. It shrunk immediately after cross clamping of the aorta demonstrated that it remained under arterial pressure. The aneurysm was opened, with a large amount of old clot removed, and the vein graft was transected at the aorta and over sewn. A radial artery conduit was placed on the LAD, although no OM vessels were seen to allow grafting. The patient was discharged on day 14 after surgery and is currently convalescing. Saphenous vein graft aneurysms are uncommon, but usually present more than 10 years after initial surgery. Both operative and conservative management have been advocated. Due to the rare nature of such a complication, we would advocate a multidisciplinary approach with input from noninvasive and invasive cardiologists prior to con- sidering definitive surgical management. Address correspondence to Dr Austin, Cardiothoracic Division, James Cook University Hospital, Marton Rd, Middlesbrough, TS4 3BW UK; e-mail: [email protected]. Fig 1. Fig 2. © 2011 by The Society of Thoracic Surgeons Ann Thorac Surg 2011;92:742 • 0003-4975/$36.00 Published by Elsevier Inc doi:10.1016/j.athoracsur.2011.01.096 FEATURE ARTICLES
