Coronary Bypass Graft Pseudoaneurysm Successfully Treated by PTFE-Covered Jostent GraftMaster

J INVASIVE CARDIOL 2018;30(5):E41.

Key words: pseudoaneurysm, coronary artery bypass graft surgery, complications

A 60-year-old male with coronary artery disease s/p CABG with LIMA to OM, SVG to LAD, and SVG to PDA with jump graft to distal RCA presented 12 months post op with a large pulsatile sternal mass. He first noticed it 2 months post surgery and finally sought evaluation after 10 months of progressive enlargement. CT scan of the chest demonstrated a pseudoaneurysm originating from the mid saphenous vein graft to PDA measuring 7.7 x 7.2 x 6.0 cm. After a multidisciplinary consultation, a decision was made to place a Jostent GraftMaster (Abbott Vascular) to completely seal the communication of the extravasation.

The patient was electively admitted to the catheterization lab. Bilateral 8 Fr femoral arterial access was obtained. An 8 Fr Multipurpose guiding catheter was used to engage the SVG to RCA. A 0.014˝ Prowater guidewire was passed through the vein graft into the distal native RCA. Percutaneous coronary angioplasty was performed with a 3.0 x 15 mm Apex OTW balloon (Boston Scientific) and intracoronary stenting was performed with a 3.5 x 26 mm Jostent GraftMaster (Video 1). Postdilation was performed with a 4.0 x 15 mm NC Quantum balloon with high inflation pressures (Figure 1). IVUS post stent placement revealed good stent expansion and apposition, without edge dissection (Video 2).

SVG pseudoaneurysm complications occur in <5% patients after CABG. Early recognition is crucial to avoid catastrophic complications of pseudoaneurysm rupture. Treatment options include coil embolization of the pseudoaneurysm, placement of an Amplatzer vascular plug in the neck of the pseudoaneurysm, placement of covered stents, and surgical treatment. A PTFE-covered Jostent was successfully deployed for this patient, yielding good results. The patient remained asymptomatic at 2-year follow-up, with no pseudoaneurysm detected on repeat CT scan.

View the accompanying Video Series here.

From Hartford Hospital, University of Connecticut, Hartford, Connecticut.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted January 26, 2018. 

Address for correspondence: Saqib Ali Gowani, MD, Hartford Hospital, University of Connecticut, 85 Seymour Street, Hartford, CT 06106. Email: saqibgowani@gmail.com