Contained Spontaneous Saphenous Vein Graft Rupture Status Post CABG: Optimal Approach to Diagnosis and Treatment

Case Report

Austin Med Sci. 2022; 7(2): 1068.

Contained Spontaneous Saphenous Vein Graft Rupture Status Post CABG: Optimal Approach to Diagnosis and Treatment

Ha QD1, Pham HN2, Dang CTM3, Liu IZQ4, Hoang T5, Pham T3, Tran VN1, Huynh BD1, Nguyen DNC1, Phan V1, Pham D1, Nguyen N6, Chung D6, Pham S7, Tran P8*

1Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

2Department of Cardiovascular Medicine, University of Milan, Italy

3Hue University of Medicine and Pharmacy, Vietnam

4Midwestern Osteopathic University, USA

5Vietnam Military Medical University Faculty of Medicine, Vietnam

6Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Vietnam

7Unity Health – White County Medical Center, Searcy, AR 72143, USA

8Department of Cardiovascular & Osteopathic Medicine Dignity Health – YRMC, Prescott, AZ 86301, USA

*Corresponding author: Phillip Tran DO, Department of Cardiovascular & Osteopathic Medicine Dignity Health – YRMC, Prescott, AZ, 1521 Majestic Way, Prescott, 86301, USA

Received: July 25, 2022; Accepted: August 23, 2022; Published: August 30, 2022


Spontaneous rupture of Saphenous Vein Graft (SVG) is a rare complication status post Coronary Artery Bypass Surgery (CABG). Its pathophysiology could depend on several factors including increased vessel wall stress, the size and thickness of the vessel. The optimal approach to diagnose and manage spontaneous SVG rupture remains unclear. Here, we describe a case of a 73-year-old man with a 14-year history of triple vessel CABG who presented with 8 months of chest pain and was found to have contained spontaneous SVG rupture. The chest pain was completely resolved after successful implantation of a covered stent.

Learning Points: Spontaneous rupture of SVG is worth to be considered in the differential diagnoses of chest pain status post CABG. Along with patients’ comorbidities, coronary angiogram to provide information about anatomy and hemodynamic flow can contribute to individualize the management.

Keywords: Spontaneous vein graft rupture; Covered stent; CABG complications; Chest pain status post CABG


Saphenous Vein Graft (SVG) obstruction is a common complication of CABG and the management is well studied [1]. However, contained SVG rupture is a rare complication post CABG. The optimal approach to diagnose and manage this complication is still not fully understood. Multiple factors including clinical characteristics and comorbidities should be considered to decide the best approach of management.

Case Presentation

A 73-year-old-man was referred to cardiology for evaluation of chronic chest pain and abnormal chest Computed Tomography (CT) scan. A routine follow-up chest CT for a lung nodule showed accumulation of hematoma/seroma in the anterior mediastinum. On review of symptoms, he has experienced chronic significant precordial chest pain for at least 8 months. The pain was described as chest heaviness, associated with dyspnea on exertion and has not changed since it started. Medical history was significant for triple vessel CABG 14 years ago, persistent atrial fibrillation, hypertension, peripheral vascular disease, and mitral valve regurgitation. Electrocardiogram (ECG) demonstrated atrial fibrillation with rapid ventricular response heart rate of 109. His clinical scenario and CT scan raised high suspicion of graft aneurysm versus contained rupture of bypass graft.

Coronary angiogram revealed a severe calcific triple-vessel coronary artery disease with chronic total occlusion of Right Coronary Artery (RCA) including SVG, patent left internal mammary artery to left anterior descending artery, spontaneous contained rupture of distal portion of sequential saphenous vein graft to diagonal and obtuse marginal branch with extensive collateral to the RCA (Figure 1).