Giant Aneurysm of In Situ Saphenous Vein Graft

We report a case of a symptomatic and rapidly expanding aneurysm of an in situ saphenous vein graft in a 70-year-old man with extensive prior open and endovascular procedures for aneurysmal disease. He was found to have full-length aneurysmal dilation with rapid progression over the course of 6 months. Successful ligation and exclusion with subtotal excision of the aneurysmal segment was performed, and revision bypass was foregone because of adequate distal perfusion via collateralization. This rare complication of autologous vein bypass graft typically occurs at the anastomoses and merits aneurysmorrhaphy or ligation. Far less common is the scenario of nonanastomotic, true aneurysmal dilation of the entire conduit such as the current patient. Surgical intervention via open, endovascular, or a combination thereof is warranted for rapidly growing or symptomatic defects and those yielding distal malperfusion.