Hybrid Percutaneous Intervention for a Giant Saphenous Vein Graft Pseudoaneurysm

Background: Saphenous vein graft (SVG) pseudoaneurysms are uncommon complications of coronary artery bypass grafting that may expand rapidly and cause compression or rupture. Case summary: A 66-year-old man presented with non-ST-segment elevation myocardial infarction. Coronary angiography showed a patent SVG supplying the obtuse marginal branch. Six months later, he re-presented with angina, and imaging revealed a giant 80-mm SVG pseudoaneurysm compressing the pulmonary artery. Laboratory evaluation including erythrocyte sedimentation rate and C-reactive protein was negative. The patient was a surgical turndown including redo sternotomy given high operative risk. A hybrid surgical-percutaneous approach using axillary access enabled deployment of covered and drug-eluting stents, successfully excluding the pseudoaneurysm while preserving graft patency. Discussion: SVG pseudoaneurysms are rare but potentially fatal. Management depends on rupture risk, myocardial jeopardy, and surgical feasibility. Percutaneous exclusion presents a viable alternative in high-risk surgical patients. Take-home messages: Percutaneous exclusion of SVG pseudoaneurysms may preserve graft patency in high-risk surgical patients. Hybrid access strategies and heart team collaboration are essential in patients with complex vascular anatomy. Keywords: chest pain; coronary angiography; coronary artery bypass; percutaneous coronary intervention.

Citation

Ibrahim et al (2026). Hybrid Percutaneous Intervention for a Giant Saphenous Vein Graft Pseudoaneurysm. JACC. Case reports, 108316. Advance online publication. https://doi.org/10.1016/j.jaccas.2026.108316

DOI

10.1016/j.jaccas.2026.108316

URI

https://hdl.handle.net/20.500.14709/1478

License

CC-BY 4.0

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Usage rights

CC-BY 4.0

License

https://creativecommons.org/licenses/by/4.0/