case_images: PMC6956458_01
case_images: Giant aneurysm of the saphenous vein graft-obtuse marginal branch (SVG-OM) venous bypass graft. A - Coronal reconstruction of the coronary angio-computed tomography (angio-CT) depicting giant, partially thrombosed aneurysm of the SVG-OM bypass graft (arrow) compressing the pulmonary trunk (asterisk). Electrode of the implantable cardioverter-defibrillator directing to the right ventricle visible as well (arrowheads). B - Pre-procedural angiogram of the SVG-OM bypass graft depicting aneurysm filling with contrast medium (asterisk); a 6 Fr 90 cm-long vascular sheath (Flexor, Cook Medical, IN, USA) was placed at the level of the ascending aorta (thick arrow) through a right femoral access, followed by coaxial, selective positioning of the 5 Fr MPA (Cook Medical, IN, USA) diagnostic catheter in the proximal SVG-OM bypass (arrow). C - Preceded by administration of 3000 IU heparin i.v., a 6 mm Amplatzer Vascular Plug (AVP) 4 (arrowheads) was then deployed with a slight oversizing into the 5 mm target graft resulting in complete aneurysm exclusion from the circulation; just before AVP deployment the 6 Fr vascular sheath was advanced to the proximal SVG-OM bypass to provide system stability (arrow). The arterial puncture site was closed by StarClose (Abbott Vascular, IL, USA). The patient received low molecular weight heparin (LMWH) s.c. daily for routine postoperative thrombosis prophylaxis, and after discharge was prescribed with optimal medical treatment (acetylsalicylic acid (ASA) 75 mg, statin, angiotensin-converting-enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB)) as standard of care, not to impede the effects of AVP with additional antithrombotic agents. D - Control coronary angio-CT at 12 months depicts AVP 4 (asterisk) successfully implanted to the proximal SVG-OM bypass graft, with no residual flow through the aneurysm sac. Fully thrombosed aneurysm of the aorta-diagonal branch-left anterior descending artery (Ao-DIAG-LAD) bypass (thick arrow) with stent deployed within patent graft vessel (arrowheads) is visible as well. Electrode of the implantable cardioverter-defibrillator directing to the right ventricle visible as previously (arrow). Pulmonary trunk decompression is also visible
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case_images: Coronary CT angiograms obtained at 3 and 12 months (Figure 1 D) follow-up confirmed effective occlusion of the bypass graft with complete thrombosis of the aneurysm sac.