Surgical treatment of saphenous vein graft aneurysms after coronary artery revascularization.
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.
Sareyyupoglu
Basar
B
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Schaff
Hartzell V
HV
Ucar
Ibrahim
I
Sundt
Thoralf M
TM
Dearani
Joseph A
JA
Park
Soon J
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000517:prevention & control; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012501:Saphenous Vein; D016896:Treatment Outcome; D055815:Young Adult