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

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.