Aneurysm of a Saphenous-Vein Bypass Graft

A 75-year-old man who was taking 8 mg of prednisone per day for systemic lupus erythematosus was admitted for the evaluation of an enlarging chest mass. Seventeen years earlier he had undergone aortocoronary saphenous-vein grafting. Two years before presentation, he had coronary angiography for recurrent chest pain. A chest x-ray film showed a small, rounded irregularity of the right lateral aspect of the cardiac silhouette (arrows in Panel A). A calcified 90 percent stenosis of the proximal native right coronary artery was found. The right saphenous-vein graft was patent and had an aneurysm measuring 8 by 10 mm that was 2 cm from the origin of the graft. Stenting of the stenotic se g m ent restored normal blood flow, and the patient's chest pain disappeared. Two years later, a follow-up chest x-ray film showed that the mass had enlarged (arrows in Panel B ). The native right coronary artery was still patent, but the graft had a rounded aneurysm (A in Panel C ) that was 6 to 7 cm in diameter. Contrast material slowly filled the distal se g m ent of the graft (arrows in Panel C ). Wire coils were advanced through a catheter into the graft distal and proximal to the aneurysm. Within 20 minutes, flow into the proximal portion of the aneurysm was substantially reduced. No distal flow was seen. Subsequent imaging studies showed no activity in the region of the thrombosed aneurysm. No chest pain occurred during the subsequent 14 months of follow-up.




如图所示：

男性，75岁，系统性红斑狼疮，每日口服强的松8mg，因胸片心影增大入院。17年前曾行冠状动脉大隐静脉旁路移植术。2年前因为胸痛再发而行冠脉造影术。胸片提示心影右侧一个小的圆形异常影(箭头，图A)。右冠狭窄90% ，伴钙化。右大隐静脉桥通畅，但是在距主动脉端2cm 处有一8-10mm的动脉瘤。行右冠状动脉支架植入后血流通畅，胸痛缓解。, 两年后，胸片显示心影扩大箭头，图B )。右冠状动脉血流通畅，但是静脉桥出现了一个圆形的动脉瘤(A ， 图C ) ，直径6-7cm。对比剂缓慢充盈桥血管远端 (箭头，图C )。使用导管将弹簧圈置入桥血管动脉瘤的远近端，20分钟后，动脉瘤近端血流显著减少，远端血流消失。随即造影，显示动脉瘤已被成功栓塞。随访14个月，无胸痛发生。