Saphenous vein graft aneurysm with graft-enteric fistula after renal artery bypass.
A 65-year-old female presented with upper gastrointestinal hemorrhage thirty years following an aorta-to-right renal artery bypass constructed with saphenous vein. Upper endoscopy demonstrated a duodenal ulcer, and a CAT scan demonstrated aneurysmal degeneration of her renal artery bypass with duodenal impingement. Laparotomy demonstrated erosion of the aneurysm through the posterior wall of the duodenum; extra-anatomic renovascular reconstruction and primary duodenal repair was performed. Although aneurysmal degeneration of intraabdominal saphenous vein grafts is well described and rupture likewise reported, this report represents the first description of an intraabdominal autogenous vein graft aneurysm presenting with gastrointestinal erosion and fistula.
Levy
Mark M
MM
Division of Vascular Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0108, USA. mmlevy@vcu.edu
Kiang
William
W
Johnson
Jason M
JM
Myers
Stuart I
SI
D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004381:Duodenal Ulcer / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006978:Hypertension, Renovascular / Q000601:surgery*; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012077:Renal Artery / Q000601:surgery*; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects*