Saphenous vein graft aneurysms; the true, false and ugly!

The reported incidence of minor dilation of reversed saphenous vein grafts used for coronary artery bypass grafting varies up to 14%, however significant aneurysmal dilation is unusual. We report on the findings and management of a series of four patients with reversed saphenous vein graft aneurysms (rSVG). These cases show some of the salient and very unusual features at presentation. rSVGs are usually asymptomatic (12-47%), however they may present with cough, unstable angina or sudden death. One of our cases presented with haemoptysis, which has only been described once previously in association with a rSVG. Diagnosis is usually done with a combination of chest X-ray, ECHO, coronary angiography and CT or MRA. Management options including coil embolisation, covered stenting and surgery are discussed. The histology of these cases exemplifies the varying pathogenesis for true and false aneurysms. Our recommendation remains that rSVGs should be treated surgically, if they show signs of enlargement, or they become symptomatic.