Author + information
- Received September 26, 2017
- Revision received October 12, 2017
- Accepted October 24, 2017
- Published online March 5, 2018.
- Ayman Jubran, MD,
- Avinoam Shiran, MD,
- Moshe Y. Flugelman, MD and
- Ronen Jaffe, MD∗ ()
- ↵∗Address for correspondence:
Dr. Ronen Jaffe, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel 34362.
An asymptomatic physically active 66-year man with a history of coronary artery bypass surgery and mitral valve replacement underwent computed tomography angiography (CTA) to evaluate the patency of the bypass grafts. CTA revealed a giant 4 cm × 4 cm aneurysm of an ectatic saphenous vein graft (SVG) near the anastomosis with the posterior descending artery (PDA) (Figures 1A and 1B). Due to the patient’s lack of symptoms and the perceived risk associated with surgical or percutaneous treatment of the aneurysm it was decided to follow him noninvasively with serial CTA studies. One month later the patient sustained a cardiac arrest with electrocardiographic evidence of inferior ST-segment elevation myocardial infarction. Emergency angiography revealed rupture of the SVG aneurysm (Figure 2, Online Video 1) with occlusion of the PDA and echocardiographic evidence of localized tamponade. The patient’s hemodynamic collapse was attributed to a combination of cardiac tamponade and extensive myocardial ischemia and decision was made to restore flow to the PDA and to seal the SVG rupture. Following stenting of the PDA with a 2.25 mm × 15 mm XIENCE Xpedition coronary stent (Abbott Vascular, Abbott Park, Illinois) the coronary guidewire was exchanged for a 0.035-inch polymer-coated guidewire (Terumo, Tokyo, Japan) via a GuideLiner catheter (Vascular Solutions, Minneapolis, Minnesota). The 6-F femoral sheath was exchanged for a 9-F sheath (90 cm length), which was inserted into the SVG over the 0.035-inch guidewire. Following deployment of a 9 mm × 60 mm fluency stent graft (Bard Medical Division, Covington, Virginia) within the SVG across the mouth of the ruptured aneurysm (Figure 3, Online Video 2) the patient stabilized hemodynamically with ST-segment elevation resolution on the electrocardiography. The patient remained unconscious due to anoxic brain damage and died 1 month later. In view of the positive relationship between the size of SVG aneurysms and risk of complications, early treatment of large asymptomatic SVG aneurysms should be considered (1).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 26, 2017.
- Revision received October 12, 2017.
- Accepted October 24, 2017.
- 2018 American College of Cardiology Foundation