Coil embolization can be successfully used to occlude an expanding saphenous vein graft aneurysm when percutaneous closure with covered stents is not possible due to lack of distal run-off.
May support coil embolization for SVG aneurysms unsuitable for stenting; hypothesis-generating case report requiring prospective validation.
An 80-year-old man with chronic stable angina and a history of coronary artery bypass grafting underwent contrast-enhanced computed tomography for investigation of aorto-iliac disease. As an incidental finding, he was noted to have a large coronary vein graft aneurysm adjacent to the right heart (Panel A). Coronary angiography 2 years previously had demonstrated a patent internal mammary artery to the left anterior descending artery and a patent vein graft to the right coronary artery with aneurysmal dilatation of the distal vein graft (Panel B). No intervention was undertaken at that time. Angiography on this occasion demonstrated considerable expansion of the vein graft aneurysm with no perceivable distal run-off (Panel C). Prolonged occlusion of the vein graft proximally with a 5 × 15 mm Maverick angioplasty balloon (Boston Scientific, Maple Grove, MN, USA) resulted in neither symptomatic nor electrocardiographic evidence of myocardial ischaemia. In the absence of a distal lumen, percutaneous closure of the aneurysm using covered stents was not possible and vein graft occlusion was achieved following deployment of two Nester 6 mm × 14 cm coils (Cook, Bloomington, Ind., USA) within the proximal segment of the vein graft (Panel D).
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Cruden et al. (2006) studied this question.
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