Saphenous Vein Graft Aneurysms - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

An aneurysm is the weakening and ballooning of an artery. An aneurysm may form in the brain, behind the knee, or the spleen. At times, aneurysms are fatal. Most of the time, they have no symptoms until and unless they rupture. On the basis of the size of the aneurysm as well as the speed with which the aneurysm or abnormal growth is being expanded, treatment differs from watchful waiting to initiate an emergency invasive surgical treatment.

Saphenous vein graft aneurysms, or SVGA are generally observed to be a rare and sporadic issue just after a coronary artery bypass graft or CABG surgery is completed. Saphenous vein graft aneurysm may result in a variety of major complications that include the compression of adjacent vital structures, development of myocardial ischemia, blood vessel rupture, and at times, death. SVGA or saphenous vein graft aneurysms can occur as an infrequent complication of a successful or unsuccessful coronary artery bypass graft with the potential of an important life-threatening consequence- mortality. The diagnosis of saphenous vein graft aneurysm along with coronary artery angiography is mostly definitive, but the exact dimensions and location of the saphenous vein graft aneurysm can be obscured in case of a mural thrombus that seems to exist.

What Is the Cause of Saphenous Vein Graft Aneurysm?

A saphenous vein graft aneurysm involves all three layers of the blood vessel. One of the most important etiological factors behind a saphenous vein graft aneurysm is atherosclerosis. Atherosclerosis is the direct result of plaque accumulation within the arteries that are responsible for the smooth flow of oxygenated blood and other vital nutrients to the brain. Plaques are clusters of fat and cholesterol and calcium, cellular debris, and fibrous tissues. These assemble and form a miniature injury within the artery, and this site becomes the playground for atherosclerosis.

In addition, carotid arteries jammed with plaques are stiff in texture and are not very wide. Thus, they have a tough time delivering oxygenated blood and nutrients to the brain structures necessary for day-to-day functioning and the heart. Infection of an underlying aneurysm is another cause of a saphenous vein graft aneurysm. Hemorrhage, varicose veins, and chronic use of steroids have also been reported and studied as being the causative agents of saphenous vein graft aneurysms.

What Are the Signs and Symptoms of a Saphenous Vein Graft Aneurysm?

More than forty years ago, saphenous vein grafts were introduced into the procedure of coronary artery bypass surgery for the treatment and management of severe coronary artery stenoses. A saphenous vein graft aneurysm can be defined as an abnormal dilation and swelling of the bypassed vein that has been grafted, and this remains a rare complication with an increased risk of morbidity as well as mortality. Saphenous vein graft aneurysms are associated with extensive deposits of plaque as well as the formation of atherosclerotic debris that can easily lead to angina or myocardial infarction. Saphenous vein graft aneurysms may rupture with life-threatening adverse effects such as shock and the formation of fistula as well as the compression of surrounding tissues. Mentioned below are a few of the signs and symptoms of a saphenous vein graft aneurysm.

• Enlarged mediastinum.

• Atrial fistulas.

• Pulmonary leakage.

• Anxiety.

• Nausea.

• Vomiting.

• Dizziness.

• Fainting.

• Fatigues.

• Lightheadedness.

• Weakness.

• Rapid pulse.

• Unexplained wheezing.

• Restlessness.

• Chest pain that radiates to the neck and left shoulder.

• Deep inhalation becomes very strenuous.

• Shortness of breath that leads to rapid breathing.

• Striking pulse rates.

• Large visible veins on the neck.

• Hemoptysis (coughing up blood).

• Sweating.

• Pale skin.

• Cool hands and extremities.

• Shortness of breath.

• Chest pain gets worse over time.

• Compression of the right heart chambers.

• Cardiac tamponade (a medical emergency where fluid accumulates in the sac surrounding the heart).

• Congestive heart failure (a condition in which the heart's ability to pump blood is compromised).

• Myocardial infarction (heart attack).

• Embolization.

• Palpitations.

• Ischemia (a condition characterized by an inadequate blood supply to a specific organ or tissue).

• Presence of a gallop rhythm.

• Pleural effusion (accumulation of fluid in the space between the membranes (pleura) that line the lungs, causing compression and potential respiratory difficulties).

How to Diagnose Saphenous Vein Graft Aneurysm?

There are various tests that are done in order to determine the presence of a saphenous vein graft aneurysm. Diagnosis is based on a complete history and physical examination of the patient. A routine visit to the healthcare provider may include a blood pressure check, listening to arteries of the neck and knees, as well as palpating the abdomen for any mass. Mentioned below are a few of the diagnostic measures to determine the presence of a saphenous vein graft aneurysm.

• Ultrasound abdomen.

• Computed tomography abdomen.

• Computed tomography heart.

• Magnetic resonance imaging.

• Electrocardiography.

• Echocardiography.

• Coronary angiography.

• Cardiac biomarkers.

• Cardiac enzymes.

• Tests for troponin levels.

• A complete blood picture.

• Lipid profile evaluation.

• An exhaustive metabolic panel.

• Chest x-rays.

• Fluid analysis.

How to Treat Saphenous Vein Graft Aneurysm?

There is not great variations and option available in the treatment of saphenous vein graft aneurysm. The surgical approach is supposed to be one of the most commonly done and widely used treatment strategies with a positive outcome in the majority of cases.

Conclusion:

The saphenous vein is a vein that is found in the leg which drains blood and back to the heart by traveling along the front and back of the calf. Saphenous veins are a part of the superficial venous circulatory system. The legs additionally have a deeper venous system. The majority of the problems that are related to varicose veins and venous insufficiency are because of the leaky valves in the saphenous veins. A saphenous vein graft aneurysm is one of the complications of coronary bypass surgery. It is when the vein develops an aneurysm in its route and has the risk of bursting, leading to compression of the nearby structures and causing havoc in the entire cardiovascular system. There are several ways to diagnose the presence of a saphenous vein graft aneurysm. The signs and symptoms may be parallel to cardiac arrest, congestive heart failure, cardiac tamponade, and coronary artery disease because these are the adverse effects of untreated and long-standing saphenous vein graft aneurysms. The treatment is generally a surgical correction of the aneurysm.