A 72-year-old man, who underwent coronary artery bypass grafting 14 years previously, presented with sharp posterior chest pain and presyncope.
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Computed tomography (CT) demonstrated aneurysmal dilatation of a saphenous vein graft with irregularity of the aneurysmal sac suggestive of rupture and moderate haemo-pericardium (figures 1 and 2).
Invasive angiography showed no residual leak with modest perfusion of the distal vessel. The size of the aneurysmal segment and the presence of distal perfusion precluded the use of a polytetrafluoroethylene ‘covered’ stent or occlusion device. He remained haemodynamically stable and pain free, and the effusion resolved. Giant (>4 cm) saphenous vein graft aneurysm formation is a rare but potentially fatal late complication of bypass surgery.
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