Rapidly Expanding Aneurysms in Cryopreserved Vein Grafts

Abstract

Cryopreserved saphenous vein allografts have been used as an alternative conduit for lower extremity revascularization when suitable autogenous vein is unavailable. Failure of such grafts has usually been attributed to early thrombosis, resulting in poor overall patency rates. Aneurysmal degeneration, is, however, a disease process occurring in cryopreserved vein grafts that may be life-threatening. The authors have previously reported their early experience with cryopreserved saphenous vein allografts in a series of 39 lower extremity bypass grafts in 35 patients. This report did not describe sudden aneurysmal changes in the cryopreserved vein grafts. Herein they report 3 grafts in 2 patients of the same series that developed rapidly expanding aneurysms necessitating emergency operation. All cases were successfully managed. This experience now prompts them to suggest that frequent duplex imaging of all cryopreserved saphenous vein allografts is prudent and that surgical intervention for even mild aneurysmal changes is appropriate. Although aneurysmal degeneration has not been reported in cryopreserved vein grafts utilized in the aortocoronary position, the consequences of such potential rapid expansion are such that serious consideration of the original indications for placement seems appropriate.