Contained Rupture of a Saphenous Vein Graft Pseudoaneurysm Following Coronary Artery Bypass Grafting.

Saphenous vein graft (SVG) pseudoaneurysms are a rare cause of late graft failure with potentially lethal consequences if left untreated. We present the case of a patient who underwent multivessel coronary artery bypass grafting more than 10 years earlier and presented with chest pain. She was found to have a large 10 cm pseudoaneurysm involving the SVG-to-PDA graft. Workup demonstrated compression of the right ventricle by the pseudoaneurysm, a reduced ejection fraction of 27%, and filling of the pseudoaneurysm from the right coronary system without distal graft filling. Given the patient's symptoms, imaging findings, and pseudoaneurysm size, urgent resection and revascularization were performed. Postoperatively, ventricular function improved, and despite a complicated hospital course, the patient was discharged to rehabilitation with intact motor function and subsequent resolution of cardiopulmonary symptoms.