Staged stenting of a long aneurysm of a saphenous vein coronary artery bypass graft

A 65-year-old male who underwent coronary artery bypass graft surgery (CABG) 21 years ago and received a mitral valve annuloplasty 5 years ago presented with recurrent angina. Computed tomography showed an aneurysm of the saphenous vein graft (SVG), measuring approximately 43 x 33 mm with mural thrombus. Diagnostic catheterization showed that the SVG to the marginal branch of the left circumflex artery had a large aneurysm with mural thrombus, which measured 32 x 45 mm. The lesion was pretreated with a 5.5 x 47 mm Magic Wallstent (Boston Scientific, Maple Grove, Minnesota) followed by 4.0 x 26, 4. x 26, 4.0 x 19 and 4.0 x 16 mm PTFE-covered stents. Postdilatation was performed using a 5.0 x 20 mm balloon. Because of significant flow from the distal end of the PTFE-covered stents seen at coronary angiography after 6 months, we implanted another 4.0 x 26 mm PTFE-covered stent at the distal edge of the previous stent. Final angiography and intravascular ultrasound showed no significant flow into the aneurysm.