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.