Despite ongoing advances in percutaneous revascularization, coronary artery bypass grafting (CABG) continues to be performed in a large number of patients, with 400 000 operations reported in 2007 in the United States alone.1 Although arterial conduits are generally preferred, saphenous vein grafts (SVGs) continue to be used regularly. First described by Riahi and colleagues 2 in 1975, aneurysmal dilatation of aortocoronary SVGs remains a rare yet widely reported phenomenon. Indeed, subsequent literature on the topic consists almost exclusively of case reports and small case series. Thus, the precise incidence of aortocoronary SVG aneurysms (SVGAs) remains difficult to ascertain, although in 1 case series, an incidence of 0.07% was estimated from a review of 5500 grafts at a single institution.3 However, this likely underestimates the true number because SVGAs often remain clinically silent and no guidelines exist to screen for their development. Given the infrequent identification of SVGAs, our current understanding of the epidemiology and pathogenesis of these aneurysms remains limited. Aneurysms are generally defined as a focal dilatation of vessels 1.5 times the proximal reference diameter; however, aneurysmal dilatation of aortocoronary SVGs has led to “giant” aneurysm formation, with reports of cases exceeding 10 cm.4–6 SVGAs are often incidentally identified on imaging, but cases of rupture,7 fistula formation with neighboring anatomy,8 and hemodynamic compromise resulting from compression of adjacent cardiac and vascular structures have been reported.9 To date, 2 reviews have been published that briefly summarize 108 cases of SVGAs. 10,11 Traditionally, their management has been surgical—generally resection of the aneurysm with or without bypass of the affected territory. However, with refinement of percutaneous techniques, including the use of Amplatzer devices, covered stents, and arterial coiling, the management options for affected patients are becoming increasingly diverse, and consensus on the optimal approach to managing SVGAs remains unclear. Therefore, we performed a systematic review of published cases as has been reported for other very rare clinical conditions to determine the natural history and management of SVGAs.12,13 Details regarding the methodology, search strategy, and results can be accessed in the online-only Data

Contemporary Reviews in Cardiovascular Medicine Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms A Systematic Review of Published Cases

Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease. It is well known that the long-term clinical outcome after myocardial revascularization depends on the patency of the bypass grafts. In the past, invasive coronary angiography was used to assess the status of the grafts and check for graft occlusion. Recently, computed tomography (CT), particularly multidetector CT with electrocardiographic gating, has emerged as an important diagnostic tool for evaluation of CABGs in both the early ( 1 month) postoperative settings. A variety of postoperative complications may manifest as dyspnea and chest pain, thereby mimicking recurrent angina secondary to graft occlusion. Owing to its improved spatial resolution compared with that of earlier-generation CT scanners and its ability to produce three-dimensional and multiplanar images, multidetector CT has assumed an integral role in characterization of graft patency while allowing investigation of alternative postoperative complications. In addition, the expanded capabilities of volumetric imaging may provide valuable information in preoperative planning for repeat CABG surgery.

Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings.

Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization

Devices for modern heart support are minimized to reduce priming blood volume and contact area with foreign surfaces. Their flow fields are partly governed by very high velocity gradients. In order to investigate blood damage, porcine and human blood was passed through a narrow Couette type shear gap applying defined high shear rates within the typical range for devices such as blood pumps or artificial heart valves (gamma = 1800/s to 110,000/s for 400 ms). Traumatization profiles of both blood species were recorded in terms of hemolysis and platelet count. Sublethal damage in terms of platelet (PF4) and complement activation (C5a) was additionally measured for human blood. Results for porcine and human blood were very similar. Hemolysis was not started until critical shear rates of about 80,000/s. Impact on platelets was severe with drops in cell count of up to 65% (at gamma = 55,000/s to 110,000/s) likely to set stronger limits to the design layout of devices than hemolysis. Concentrations of PF4 and C5a clearly increased with shear rate exhibiting stronger gradients where hemolysis started. Due to the similar results of porcine and human blood for hemolysis and platelet drop, porcine blood seems to be suitable for device testing. Selection of blood species would thus depend on handling, availability and analysis demands.

In vitro blood damage by high shear flow: human versus porcine blood.

Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade.

Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.

Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications

Saphenous Vein Graft Pseudoaneurysm Rupture After Coronary Artery Bypass Grafting

Mechanical trauma caused by centrifugal pumps is usually evaluated in terms of hemolysis. However, platelet damage caused by centrifugal pumps has not been studied well. We evaluated platelet damage in 2 different centrifugal pumps, the Medtronic BioMedicus BP-80 and the Terumo Capiox, in vitro and compared the results in terms of hemolysis. To evaluate platelet damage, the rate of increase (RI) for beta-thromboglobulin (beta-TG) and platelet factor-4 (PF-4) were measured by enzyme immunoassay. RI was defined as follows: RI for beta-TG is deltabeta-TG/deltaN and RI for PF-4 is deltaPF-4/deltaN where deltabeta-TG is the increase in beta-TG, deltaPF-4 is the increase in PF-4, and deltaN is the increase of the passing number, which is defined in the following equation: N = Qt/V (t, time; V, priming volume; Q, flow rate). Each pump was tested in a mock circuit for 3 h under a flow rate of 5 L/min and a pressure head of 100 mm Hg using fresh human heparinized blood (n = 5). For comparison, the normalized index of hemolysis (NIH) values were calculated for both pumps. The NIH values did not indicate a significant difference between the Capiox and the BP-80 pumps (Capiox vs. BP-80, 0.0021 +/- 0.0004 vs. 0.0034 +/- 0.0007, NS). However, the RI values for beta-TG and PF-4 in the Capiox were significantly lower than in the BP-80 (beta-TG, 0.198 +/- 0.047 vs. 0.376 +/- 0.049; PF-4, 0.080 +/- 0.014 vs. 0.268 +/- 0.043, p < 0.05). In conclusion, although there was no significant difference between the 2 pumps in terms of hemolysis, the Capiox centrifugal pump induced less platelet damage than the BP-80. The results suggest that measurements of RI for beta-TG and PF-4 are more sensitive parameters than NIH values for evaluating blood cell damage.

Evaluation of Platelet Damage in Two Different Centrifugal Pumps Based on Measurements of α‐Granule Packing Proteins

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Saphenous Vein Graft Pseudoaneurysm Rupture After Coronary Artery Bypass Grafting

Evaluation of Platelet Damage in Two Different Centrifugal Pumps Based on Measurements of α‐Granule Packing Proteins