IMAGES IN CARDIAC SURGERY
Spontaneous rupture of an aortocoronary saphenous
Yasuhiro Matsuda MD
Atsushi Nagasawa MD
Tadaaki Koyama MD
Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe City, Hyogo, Japan
Yasuhiro Matsuda MD, Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Kobe City, Hyogo
Saphenous vein grafts may develop aneurysmal changes which may
enlarge and require surgery or exclusion with a stent.
rupture of a saphenous vein graft (SVG) in the absence of a
pseudoaneurysm is rare. We present images of a spontaneous rupture
of a SVG in the absence of a pseudoaneurysm.
An 82-year-old male had undergone a total arch replacement and
a SVG to the right coronary artery (RCA) 2 years ago. He was now
admitted with chest pain and altered mental status. A computed
tomogram showed extravasation from the proximal portion of the SVG
(Figure 1). A redo sternotomy was performed and cardiopulmonary
bypass was instituted with cannulation of the right common femoral
artery and vein. Active bleeding was noted from the proximal portion
of the SVG which was totally disrupted. The site of the disruption was
2-mm distal to the proximal anastomosis which was placed on the
ascending aortic Dacron graft (Figure 2). There was no evidence of a
SVG pseudoaneurysm. A side biting clamp was placed on the proximal
anastomosis and the defect was closed with a pericardial patch
(Figure 3). The distal graft was oversewn with a 5-0 prolene suture.
FIGURE 1 The enhanced computed tomography scan shows
extravasation between the vascular prostheses of the ascending
aorta and saphenous vein graft
FIGURE 2 The top of the forceps indicates the distal ruptured
site with bleeding
J Card Surg. 2018;33:99–100. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.