Aga Khan University Hospital, Karachi, Pakistan.
Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 2020 Oct;70(10):1848-1850. doi: 10.5455/JPMA.301599.
Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as the patient suffered ventricular arrhythmia for which cardiopulmonary resuscitation (CPR) was done. After CPR, haematoma appeared on the left side of the sternum subcutaneously. CT scan of the chest was conducted which showed a pseudoaneurysm measuring 35 mm in the mid-segment of reverse saphenous vein graft (RSVG) to the right posterior descending artery (RPDA) with a surrounding mediastinal haematoma communicating with subcutaneous haematoma, so RSVGA to RPDA was coiled. As blood culture grew candida, antifungal medication was started. When the patient's condition stabilised he was discharged.
逆行隐静脉移植瘤破裂（RSVGA）是冠状动脉旁路移植术后发生的一种罕见并发症。逆行隐静脉移植的真菌性动脉瘤更为罕见。我们描述了 1 例 76 岁男性患者，10 年前接受了冠状动脉旁路移植术，术后 4-5 个月发生了纵隔炎。他于 2017 年 7 月出现胸痛，被诊断为 NSTEMI。血管造影显示左主干冠状动脉病变（90%），伴逆行隐静脉移植至右后降支（RPDA）的动脉瘤。由于患者发生室性心律失常，需要进行心肺复苏（CPR），因此紧急进行了左主干经皮冠状动脉介入治疗（PCI）。CPR 后，胸骨左侧皮下出现血肿。进行了胸部 CT 扫描，显示在逆行隐静脉移植至右后降支（RPDA）的中段有一个 35mm 的假性动脉瘤，伴有纵隔血肿与皮下血肿相通，因此对 RPDA 处的 RSVGA 进行了弹簧圈栓塞。由于血液培养出了念珠菌，开始使用抗真菌药物。当患者病情稳定时，他出院了。
