Saphenous Vein Grafts were introduced to the technique of coronary artery bypass surgery for the treatment of severe coronary artery stenoses more than 40 years ago (1,2). Saphenous vein graft aneurysm defined as abnormal dilation of the bypassed vein graft remains a rare complication but increases the risk of morbidity and mortality (3,4). Vein graft aneurysms are associated with extensive plaque and atherosclerotic debris and can lead to angina and myocardial infarction both with graft occlusion and distal embolization (3,4,5). Saphenous vein aneurysms can rupture with devastating effects leading to shock or fistula formation and also cause compression of surrounding structures. This can lead to enlarged mediastinum (4), atrial fistulas (3), pulmonary leakage with hemoptysis (3), and repeat coronary artery bypass grafting (4). In my practice, I have reported, a leaking saphenous vein graft aneurysm large enough to compress the right heart chambers causing tamponade physiology (4).