Aneurysmal degeneration and late rupture of an aortorenal vein graft: Casereport, review of the literature, and implications for conduit selection

The saphenous vein is among the most commonly used conduits for renal arter y revascularization in adults. Vein grafts are more durable in the renal ar tery bed than in coronary and peripheral beds, and mechanisms of potential graft failure vary. Coronary vein grafts often fail because of atherosclero tic degeneration, whereas lower extremity grafts fail because of intimal hy perplasia or progression of underlying disease. In contrast, renal vein gra fts may dilate over time but seldom fail. This may relate to the distinct h emodynamic environment of the renal bed with low-resistance, high-velocity blood flow. However, frank aneurysmal degeneration of renal vein grafts is rare with only a single report of rupture in the literature. We report an a dditional case of rupture of a late graft aneurysm and review the literatur e and our own experience with renal revascularization to underscore the rar ity of this serious complication. The saphenous vein for aortorenal bypass grafting continues to be a favorable conduit for renal revascularization. L ong-term duplex ultrasound scanning follow-up is recommended to survey the reconstructed artery and perhaps more important, to evaluate progression of subclinical disease in the contralateral renal artery.