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A 64-year-old woman attended for elective coronary angiography for investigation of atypical chest pain. She had undergone emergency saphenous vein bypass grafting to her left anterior descending coronary artery 19 years previously following dissection of the left main stem during diagnostic-coronary angiography. She also had previous bilateral mastectomies with extensive scarring of the chest wall.
Her current angiogram shows a patent vein graft (arrow) filling retrogradely from the left anterior descending coronary artery and a fully healed left main stem. Her native coronary arteries were normal. Her symptoms of chest pain were thought to be due to her extensive chest wall scarring and not coronary disease. The patient was discharged with no further follow-up.
It is unusual to see such a patent, pristine saphenous vein graft 19 years after coronary artery bypass surgery. This may be related to the absence of the usual risk factors for atherosclerosis as in this case, and illustrates that the age of the graft is not the sole determinant of vein graft degeneration that so commonly causes problems late after coronary artery bypass surgery surgery.
This article has been adapted from Asghar Omar, Rao Archie, Ramsdale David. Rescue saphenous vein graft, 19 years on Heart 2007;93:509
Competing interests: None declared.
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