Degenerative venous aneurysm of a reverse saphenous vein femoral artery to femoral artery cross over graft: Case report and literature review of saphenous vein graft aneurysm

A true aneurysm formation in an arterialized vein graft used for lower limb arterial occlusive disease is a rare complication. The saphenous vein is the preferred conduit for infrainguinal bypass. For extra-anatomical bypass-like femorofemoral crossover, a synthetic graft is preferred. A successful outcome of femorofemoral crossover bypass with autogenous vein is well described. This case report is regarding a 67-year-old male who underwent femorofemoral crossover bypass with reversed saphenous vein graft 15 years ago for arterial occlusive disease, who now presented with degenerative aneurysm of the graft with an incidental infrarenal Abdominal Aortic Aneurysm. He underwent aortobifemoral bypass with jump graft to right internal iliac artery and resection of aneurysms. Histopathology of venous aneurysmal wall showed graft wall calcification with fibrin and collagen deposits. The causes of saphenous vein graft aneurysm have been described to be mostly atherosclerotic but it may be a part of systemic dilating pathology.