A saphenous vein graft aneurysm with fistula development to the right atrium: surgical management of a rare bypass graft complication.

A patient presented late following coronary artery bypass surgery with recurrent angina. Investigations revealed a saphenous vein graft aneurysm, which subsequently formed a fistula with the right atrium. This was managed by surgical excision and repair followed by regraft of the run-off territory. Intraoperatively, the left internal mammary artery, a patent graft to the left anterior descending artery, was isolated from the circulation during aortic cross-clamping by preoperative placement of a percutaneous balloon catheter within this graft. Surgery was successful and the patient was discharged symptom-free one week later.