Clinical Images

Emergency Percutaneous Treatment of Saphenous Vein Graft Perforation After Cardiac Surgery

Gustavo L. Agostini, MD1; Denise Pellegrini, MD1; Eduardo Saadi, MD, PhD2; Ricardo Lasevitch, MD1; Vitor Gomes, MD, PhD1; Diego Pinheiro, MD1; Ricardo Soccol, MD1; Paulo Caramori, MD, PhD1

From the Divisions of 1Cardiology and 2Cardiovascular Surgery, Hospital São Lucas, Pontifical Catholic University of RS, Porto Alegre, Brazil

Gustavo L. Agostini, MD1; Denise Pellegrini, MD1; Eduardo Saadi, MD, PhD2; Ricardo Lasevitch, MD1; Vitor Gomes, MD, PhD1; Diego Pinheiro, MD1; Ricardo Soccol, MD1; Paulo Caramori, MD, PhD1

From the Divisions of 1Cardiology and 2Cardiovascular Surgery, Hospital São Lucas, Pontifical Catholic University of RS, Porto Alegre, Brazil

A 58-year-old woman presented to the emergency department with a non-ST segment elevation myocardial infarction. She was referred for coronary artery bypass graft surgery due to severe multivessel coronary artery disease.

In the immediate postoperative period, the patient had excessive bleeding through the chest drains and hemodynamic instability, followed by total atrioventricular block requiring use of temporary pacemaker, which precluded electrocardiographic interpretation. During the next hour, bleeding reduced but the patient remained hemodynamically unstable and was referred for urgent diagnostic coronary angiography.

Angiography demonstrated important contrast leakage from the distal body of the saphenous vein graft to the first marginal branch (Figures 1A-1C; Video 1).

 

 

Remaining grafts were patent. After a cardiac arrest responsive to cardiopulmonary resuscitation during the angiography, we elected to proceed with percutaneous treatment. Using an 8 Fr, Judkins right (JR) 4.0 guiding catheter, a 5.0 x 38 mm Atrium Advanta V12 stent-graft (Getinge) was released at the bleeding site. Control angiography showed no contrast extravasation and Thrombolysis in Myocardial Infarction 3 flow (Figures 1D-1F; Video 2). The patient responded with rapid hemodynamic improvement. Subsequently, she developed multiple complications and died 50 days after coronary artery bypass graft surgery.

Acute saphenous vein graft perforation following coronary artery bypass graft surgery is rare. To the best of our knowledge, this is the first case report of acute saphenous vein graft perforation after coronary artery bypass graft surgery treated with a stent-graft. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 9, 2020.

Address for correspondence: Paulo Ricardo Avancini Caramori, MD, PhD, Hospital Sao Lucas Porto Alegre, RS Brazil. Email: caramori@cardiarte.com.br

Reprinted with permission from Agostini GL, Pellegrini D, Saadi E, et al. Emergency percutaneous treatment of saphenous vein graft perforation after cardiac surgery. J Invasive Cardiol. 2021 Mar; 33(3): E233-E234. Copyright 2021 HMP Global.