Utility of Noninvasive Imaging in Suspected Saphenous Vein Graft Aneurysm Thrombosis

A 70-year-old man presented with 2 weeks of progressive typical angina without myocardial infarction. He had undergone coronary artery bypass grafting (CABG) in December 2006, using a left internal mammary graft to the left anterior descending artery, saphenous vein grafts (SVG) to the distal right coronary artery, and the second obtuse marginal branch of the left circumflex coronary artery. Coronary angiography showed a patent left internal mammary and SVG to the right coronary. The SVG to the circumflex filled slowly and was occluded midgraft without apparent distal perfusion of the circumflex system. Instead, on late angiographic images, contrast diffusion into an indistinct aneurysmal structure was noted (online-only Data Supplement Video 1). The native circulation had a calcified 95% distal left main stenosis and no …