DOI: https://doi.org/10.36347/sjmcr.2025.v13i10.114

Pages: 2657-2662

Background: An in-situ saphenous vein bypass graft pseudoaneurysm represents a highly infrequent late complication. A 56-year-old male who had undergone femoropopliteal bypass surgery using an in-situ great saphenous vein nine years prior developed an unnoticeable false aneurysm located in the middle portion of the graft. We examine vein graft aneurysms, including their frequency of occurrence, pathogenesis, diagnostic methods, and treatment options. Case Summary: The patient exhibited an unnoticeable bulge in the middle of his thigh where the graft ran. The duplex ultrasound and CT angiography revealed a 22×34 mm pseudoaneurysm within the vein graft body, located away from the anastomoses while maintaining distal blood flow. Peripheral pulses showed a triphasic pattern, while the patient displayed no signs of infection or trauma. Open surgery involved excising the aneurysmal section containing organized thrombus and calcification, followed by end-to-end anastomoses of the graft ends. The patient experienced an uneventful recovery process with preserved limb blood flow. Discussion: Non-anastomotic vein graft pseudoaneurysms occur less than 0.1% of the time in grafts and manifest several years following surgery due to degenerative changes. True vein graft aneurysms affecting all vessel layers are sporadic and frequently associated with systemic aneurysmal conditions and atherosclerotic changes. The development of vein graft pseudoaneurysms results from prolonged arterial pressure contact, altered vein wall structures, and blood flow stress. Establishing a proper diagnosis through duplex and imaging tests enables healthcare professionals to choose the most appropriate management approach. Surgical excision of the graft and graft reconstruction is the definitive therapeutic approach for preventing rupture, although high-risk patients may receive endovascular stent graft exclusion. Autologous vein grafts require continuous lifetime monitoring because they can develop la