Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series.
BACKGROUND
The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA.


METHODS
Retrospective analysis of the patients treated with SVGA was performed at our institution. Demographic and co-morbidity data were acquired on the patients. Patients who underwent surgical treatment were compared to those treated conservatively with the primary outcome being survival time from diagnosis of the SVGA.


RESULTS
Thirteen patients with 15 SVGA were identified. The average age at the time of the most recent coronary artery bypass grafting (CABG) was similar in the conservative and the surgically treated groups (55 vs. 56.5 years, respectively). The average number of grafts per patient at the most recent CABG was similar (3.83 vs. 4.0, respectively). The average time from CABG to diagnosis was similar in both the groups (12.6 vs. 15 years, respectively). The average survival from diagnosis was similar in both the groups (2.3 vs. 1.5 years, respectively, p>0.05).


CONCLUSIONS
Early surgical treatment of SVGA does not provide longer short-term survival compared with conservative management. A treatment algorithm for SVGA based upon patient co-morbidities and aneurysm characteristics is proposed.
Dieter
Robert S
RS
Section of Cardiovascular Medicine, University of Wisconsin, Madison 53792, USA. rsd@medicine.wisc.edu
Patel
Ashvin K
AK
Yandow
Donald
D
Pacanowski
John P
JP
Bhattacharya
Abhik
A
Gimelli
Giorgio
G
Kosolcharoen
P
P
Russell
Douglas
D
D000328:Adult; D000368:Aged; D000465:Algorithms; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery / Q000637:transplantation*; D016019:Survival Analysis; D016896:Treatment Outcome