An aneurysm of a saphenous vein graft (SVGA) is a rare late complication of coronary artery bypass grafting (CABG). We present a case of a 75-year-old retired family physician who underwent CABG in 1984 and 1991. At the second procedure, all previous grafts were tied off and de novo aortocoronary reverse SVG grafts were placed to the posterior descending coronary artery, obtuse marginal artery (OM), and left anterior descending coronary artery (LAD). The patient represented 19 years after his second CABG with a non-ST elevation myocardial infarction, and recent history of exertional dyspnea. A chest roentgenogram (Fig 1) revealed a left hilar mass. Computed tomographic scan (Fig 2A) and reconstructed computed tomographic coronary angiogram (Fig 2B) show an SVG aneurysm, believed to have arisen from the OM graft (measuring 8 cm in diameter) compressing the main pulmonary artery (MPA). In view of the aneurysm size, relationship to the main pulmonary artery, and recent symptomatic status, surgical management was recommended. Standard invasive coronary angiography showed severe native disease, patent SVG to the right coronary artery, a recently occluded SVG to the LAD graft, and delineated the SVGA arising from the OM graft, which had little antegrade flow. At operation, femoral-femoral bypass was established, and a false SVGA was found arising from the distal anastamosis site of the OM graft. It shrunk immediately after cross clamping of the aorta demonstrated