Surgical Management of Recurrent Saphenous Vein Graft Pseudoaneurysm With Lung Micro-Fistulization After Repeated Percutaneous Intervention.

BACKGROUND

Saphenous vein graft stenting to treat pseudoaneurysm formation can be complicated by fistulous extensions to the bronchi with resulting hemoptysis.

CASE SUMMARY: A 72-year-old man with previous coronary artery bypass graft and multiple subsequent endovascular procedures developed recurrent saphenous vein graft pseudoaneurysms with persistent hemoptysis despite repeat stenting. Redo sternotomy enabled definitive treatment with coronary revascularization, excision of degenerated stented grafts and pseudoaneurysm, and repair of a micro-fistula extending from the saphenous vein graft into bronchial tree.

DISCUSSION: This case highlights the role of surgery in source control and structural repair after failed repeat endovascular management.