Multiple Pseudoaneurysms Following Endovascular Treatment of an Occluded Distal Bypass with a Saphenous Vein Graft: A Case Report

Abstract

Endovascular treatment (EVT) for vein graft failure is associated with various complications. A case of multiple pseudoaneurysm formation following balloon angioplasty for an occluded saphenous vein graft is reported.
An octogenarian man with a history of distal bypass surgery using the great saphenous vein for a left foot ulcer presented with ulcer recurrence due to graft occlusion. During EVT for the occluded graft, vessel rupture occurred and was managed with stent graft placement. In addition, wall irregularities suggestive of dissection were observed but were managed conservatively. One month post-procedure, multiple pseudoaneurysms developed along the vein graft at sites corresponding to previous wall irregularities. They were successfully treated with additional stent graft placement.
This case highlights the importance of careful balloon sizing and the potential progression of seemingly minor vein graft injuries to significant complications following EVT.