Thrombosis of a large saphenous vein graft aneurysm leading to acute myocardial infarction 21 years after coronary artery bypass grafting: role of cardiac multi-slice computed tomography.
We report a case of a 74-year-old male, who presented with an acute ST elevation posterior wall myocardial infarction (MI) 21 years following revascularization with three saphenous vein grafts (SVGs) to the left and right coronary arteries. In coronary angiography (CAG), the dilated SVG to the first marginal branch of the circumflex artery appeared only contrast enhanced in the proximal portion. The day after coronary angiography 128-slice cardiac computed tomography (CT) was performed. Cardiac CT showed a 5×3-cm incomplete thrombosed aneurysm of the proximal bypass with complete thrombotic occlusion of distal bypass grafting. With this diagnosis the patient was referred to a cardiothoracic unit for a second opinion. A surgical intervention was refused due to an increased intraoperative morbidity and occlusion of peripheral bypass portion. A follow-up CAG 10 days after infarction showed complete occlusion of the aneurysm. This case illustrates the utility of multi-slice CT to diagnose SVG aneurysm and influence clinical decisions for further treatment. This is the first report of a spontaneous SVG aneurysm thrombosis under a conservative treatment approach with recovery of the patient after MI. Clinical follow-up five months after infarction was unremarkable.
Department of Radiology, Berufsgenossenschaftliche Unfallklinik Duisburg GmbH, Grossenbaumer Allee 250, D-47249 Duisburg, Germany. ludger.poll@bgu-duisburg.de
Ludger Wilhelm
LW
Poll
Birgitta
B
Sadra
Sarah
S
Rühlow
Rainer
R
Wessely
D000368:Aged; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000473:pathology / Q000637:transplantation; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D013997:Time Factors; D036542:Tomography, Spiral Computed / Q000379:methods*