Tsunemi Koutaro, Mieno Shigetoshi, Yoshii Yasuyoshi, Morita Masafumi
Division of Surgery, Kyoto Katsura Hospital Cardiovascular Center, Kyoto, Japan.
Kyobu Geka. 2013 Dec;66(13):1186-9.
A 61-year-old male had undergone coronary artery bypass grafting (CABG) using a saphenous vein. Postoperative angiography represented an ascending aortic pseudoaneurysm derived from the proximal anastomotic site of the saphenous vein graft( SVG) which was connected to the obtuse marginal branch and left posterior descending branch sequentially. We performed the closure of tear and the plication of pseudoaneurysmal wall through median sternotomy on the 56th postoperative day. A 7mm length longitudinal tear in the ascending aorta close to the proximal anastomotic site of the SVG was observed. This tear was considered to be caused by the intimal injury during the anastomosis of SVG to ascending aorta. Aortic pseudoaneurysm formation close to the proximal anastomotic site of SVG is a rare and potentially lethal complication requiring urgent operation. Postoperative angiography or enhanced 3 dimensional computed tomography after CABG should be performed before hospital discharge.
一名61岁男性接受了使用大隐静脉的冠状动脉旁路移植术（CABG）。术后血管造影显示升主动脉假性动脉瘤，起源于大隐静脉移植物（SVG）近端吻合口，该移植物依次连接钝缘支和左后降支。术后第56天，我们通过正中胸骨切开术进行了撕裂口闭合和假性动脉瘤壁折叠术。观察到升主动脉靠近SVG近端吻合口处有一个7毫米长的纵向撕裂口。该撕裂口被认为是SVG与升主动脉吻合过程中内膜损伤所致。SVG近端吻合口附近的主动脉假性动脉瘤形成是一种罕见且可能致命的并发症，需要紧急手术。CABG术后应在出院前进行血管造影或增强三维计算机断层扫描。
