Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization

Basar Sareyyupoglu, Hartzell V Schaff, Ibrahim Ucar, Thoralf M. Sundt, Joseph A. Dearani, Soon J. Park

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Saphenous vein graft (SVG) aneurysms (SVGAs) after coronary artery bypass grafting (CABG) occur rarely. Most reports are anecdotal. To determine early and late outcomes of surgical treatment, we reviewed our experience with management of this rare complication of surgical revascularization. Methods: From July 1975 to October 2007, 16 patients (15 men), mean age, 60.9 ± 14.6 years, underwent repair of aortocoronary SVGAs. Results: Chest pain was present in 11 of 16 patients. The rest were asymptomatic. The average maximum diameter of the SVGA was 64 ± 30 mm. The concern of SVGA rupture was the primary indication for operation in 9 patients (56%). Repair in the remaining patients occurred during other cardiac operations. A pseudoaneurysm (75%) at the body or anastomotic sites of the SVG was the most common cause of SVGA. In 8 patients (50%), the aneurysm involved SVG anastomotic sites. Thirteen patients (81%) had intraluminal thrombi. Vein grafts with aneurysm were patent in 9 patients (56%). Surgical procedures included excision of the aneurysm and direct distal coronary target vessel revascularization in 10 (63%), excision and interposition vein graft in 5 (31%), and exclusion by ligation in 1 (6%). Median follow-up was 7 years (maximum, 20 years). Survival was 83% at 5 years and 72% at 10 years after SVGA repair. Conclusions: Ischemic symptoms often accompany SVGA, and operation is indicated to prevent rupture. Ligation or excision of SVGA with simultaneous revascularization appears to be the optimal therapy, with satisfactory midterm and long-term results.

Original languageEnglish (US)
Pages (from-to)1801-1805
Number of pages5
JournalAnnals of Thoracic Surgery
Volume88
Issue number6
DOIs
StatePublished - Dec 2009

Fingerprint

Saphenous Vein
Aneurysm
Coronary Vessels
Transplants
Therapeutics
Ligation
Rupture
Veins
False Aneurysm
Chest Pain
Coronary Artery Bypass
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization. / Sareyyupoglu, Basar; Schaff, Hartzell V; Ucar, Ibrahim; Sundt, Thoralf M.; Dearani, Joseph A.; Park, Soon J.

In: Annals of Thoracic Surgery, Vol. 88, No. 6, 12.2009, p. 1801-1805.

Research output: Contribution to journalArticle

Sareyyupoglu, Basar ; Schaff, Hartzell V ; Ucar, Ibrahim ; Sundt, Thoralf M. ; Dearani, Joseph A. ; Park, Soon J. / Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 6. pp. 1801-1805.
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abstract = "Background: Saphenous vein graft (SVG) aneurysms (SVGAs) after coronary artery bypass grafting (CABG) occur rarely. Most reports are anecdotal. To determine early and late outcomes of surgical treatment, we reviewed our experience with management of this rare complication of surgical revascularization. Methods: From July 1975 to October 2007, 16 patients (15 men), mean age, 60.9 ± 14.6 years, underwent repair of aortocoronary SVGAs. Results: Chest pain was present in 11 of 16 patients. The rest were asymptomatic. The average maximum diameter of the SVGA was 64 ± 30 mm. The concern of SVGA rupture was the primary indication for operation in 9 patients (56{\%}). Repair in the remaining patients occurred during other cardiac operations. A pseudoaneurysm (75{\%}) at the body or anastomotic sites of the SVG was the most common cause of SVGA. In 8 patients (50{\%}), the aneurysm involved SVG anastomotic sites. Thirteen patients (81{\%}) had intraluminal thrombi. Vein grafts with aneurysm were patent in 9 patients (56{\%}). Surgical procedures included excision of the aneurysm and direct distal coronary target vessel revascularization in 10 (63{\%}), excision and interposition vein graft in 5 (31{\%}), and exclusion by ligation in 1 (6{\%}). Median follow-up was 7 years (maximum, 20 years). Survival was 83{\%} at 5 years and 72{\%} at 10 years after SVGA repair. Conclusions: Ischemic symptoms often accompany SVGA, and operation is indicated to prevent rupture. Ligation or excision of SVGA with simultaneous revascularization appears to be the optimal therapy, with satisfactory midterm and long-term results.",
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