# Delayed Saphenous Vein Graft Rupture Secondary to Mediastinal Abscess: A Case Report

## TL;DR

A rare case of delayed saphenous vein graft rupture caused by a mediastinal abscess is reported, emphasizing the importance of early diagnosis in post-CABG patients.

## Contribution

This case report presents a rare complication of SVG rupture secondary to mediastinal abscess years after CABG.

## Key findings

- SVG rupture occurred five years after CABG and thoracic aortic aneurysm repair.
- The rupture was associated with mediastinal hemorrhage and infection at the graft site.
- The patient recovered after surgical intervention, hemodynamic support, and antimicrobial therapy.

## Abstract

Saphenous vein graft (SVG) rupture is a rare but catastrophic late complication of coronary artery bypass grafting (CABG). We report a 73-year-old male who presented five years after CABG and thoracic aortic aneurysm repair and was found to have a mediastinal fluid collection surrounding the ascending aorta. Emergent surgical exploration under hypothermic circulatory arrest revealed dehiscence of the SVG at its aortic anastomosis with associated mediastinal hemorrhage and evidence of infection at the graft site. The patient required postoperative pharmacologic hemodynamic support and extended antimicrobial therapy for mediastinal infection, followed by gradual clinical recovery. This case highlights the diagnostic challenge and rapid progression of late SVG dehiscence and underscores the importance of early recognition of this rare complication in post-CABG patients presenting with new mediastinal abnormalities.