Large saphenous vein graft aneurysm with a fistula to the right atrium.

We report on a case of a 65-year-old man who was admitted for anterior chest pain on effort. He had received coronary artery bypass grafting (CABG) surgery 20 years ago with saphenous vein grafts (SVGs) to the left anterior descending artery (LAD) and right coronary artery (RCA). An angiography demonstrated large aneurysmal dilatation of both grafts and a fistulous communication between the middle portion of the right SVG and the right atrium (RA). The aneurysm was excised surgically, and the fistula was closed with the right atrial wall with additional bypass grafts of the left internal thoracic artery (LITA) and gastroepiploic artery (GEA).