PMC2778144_01
(a) Computer tomography (CT) in January 2008 of chest revealing a 3.1 cm x 6.9 cm aneurysm with contrast filling the inner lumen, and possible thrombus filling the remaining space within the aneurysm. (b) Coronary angiography depicting the aneurysm of the mid SVG, with TIMI 2 flow in right posterior descending artery (PDA) in both right anterior oblique (RAO) and left anterior oblique (LAO) views.
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Follow up computer tomography (CT) scan of the chest revealed a mass worrisome for an SVG aneurysm estimated 3.1 cm in the proximal-mid section, extending approximately 6.9 cm distally and compressing the right atrium (Figure 2(a)). The patient was referred to our institution, and coronary angiography confirmed an aneurysm (Figure 2(b)) in the SVG with TIMI 2 flow to the right PDA.
(a) Placement of the Viabahn self expanding stent with two guidewires in distal SVG and no guide catheter. (b) Coronary angiography after placement of the stents with residual contrast entrapped in the aneurysm (arrows) in both RAO and LAO views with TIMI 3 flow in PDA.
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A 5 mm x 5 cm followed by a 5 mm x 2.5 cm covered stents were delivered over two wires, an Asahi Prowater coronary guide wire (Abbot Laboratories, Abbott Park, IL) and an Ironman coronary guide wire (Abbot Laboratories, Abbott Park, IL) rather than one large 0.035 inch guide wire (Figure 3(a)). TIMI 3 flow in PDA (Figure 3(b)). The patient had an uneventful hospital course and was discharged with no further chest pain.
(a) CT of the chest in April 2008 revealing aneurysm size (3.1 cm x 6.9 cm) has remained unchanged. (b) Coronary angiography in April 2008 in both RAO and LAO views revealing patent stents and no evidence of leak through the covered stents into aneurysm.
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fig4
CT scan and coronary angiography and reported being pain free and edema had not returned. CT scan revealed that the aneurysm remained unchanged at 3.1 cm x 6.9 cm (Figure 4(a)) in size. No contrast was visualized outside the lumen, and no severe lesions were seen within the covered stents (Figure 4(b)).