Bypass Graft Stent Fracture Leading to Saphenous Vein Graft Pseudoaneurysm

An 83-year-old man, with a history of coronary artery bypass graft surgery 19 years before presentation and subsequent percutaneous coronary intervention to saphenous vein graft with placement of a paclitaxel drug-eluting stent 16 years later, presented with a 2-week history of fevers, productive cough, and pleuritic chest pain. He was found to have leukocytosis and chest x-ray evidence of pneumonia with a widened mediastinum. He was admitted for treatment of protracted pneumonia. He had a borderline elevated troponin I, which, in the absence of anginal pain, was thought to be secondary to demand ischemia. A chest radiograph obtained at admission showed bilateral pleural effusions, a right lower lobe infiltrate, and a widened …