ENDOLUMINAL GRAFTING FOR PERCUTANEOUS ANEURYSM EXCLUSION IN AN AORTOCORONARY SAPHENOUS-VEIN GRAFT - THE FIRST CLINICAL-EXPERIENCE

Purpose: Aneurysms develop only rarely in aortocoronary saphenous vein grafts (SVGs), and the usual treatment is surgical replacement of the diseased segment. However, in patients at appreciable risk for redo s urgery, alternative therapies are desirable. We report the first compa ssionate use of a percutaneously delivered endoluminal graft (ELG) for internal exclusion of an SVG aneurysm. Methods: A 47-year-old male wi th two coronary bypass procedures and SVG angioplasty presented with a n 8-mm diameter aneurysm lying between 80% and 70% stenotic lesions in an SVG to the obtuse marginal branch. The risks of a third bypass ope ration were considerable, so the decision was made to attempt internal exclusion of the SVG aneurysm. Results: An ELG composed of 2.0-mm dia meter unexpanded PTFE graft material with Palmaz stents for fixation w as delivered with a low-profile system, but a second ELG was necessary for complete exclusion of the aneurysmal sac. Both ELGs were dilated after initial deployment. The patient was discharged after 9 days with out sequelae, and he remains asymptomatic with arteriographically docu mented ELG patency 5 months after treatment. Conclusions: In this pati ent with limited therapeutic options, percutaneous aneurysm exclusion in an SVG was effective in restoring a viable blood conduit. It remain s to be seen if ELGs have a potential in aortocoronary SVGs.