Accelerated atherosclerosis in tertiary syphilis and successful treatment with saphenous vein grafting--a case report

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Vascular Surgery

Background:

• Coronary artery bypass graft (CABG) surgery is a common treatment for coronary artery disease (CAD).
• Atherosclerosis, the hardening of arteries, is a primary cause of CAD, typically associated with known risk factors.

Observation:

• A 48-year-old male patient with no traditional risk factors for atherosclerosis presented with double-vessel CAD requiring CABG.
• Intraoperative findings revealed sclerosis in the aorta, bilateral internal thoracic arteries (L/R-ITA), and femoral artery.
• The patient had a confirmed diagnosis of tertiary syphilis.

Findings:

• Tertiary syphilis was identified as the underlying cause of widespread arterial sclerosis in a patient lacking conventional atherosclerotic risk factors.
• The observed arterial calcification varied in severity across different vessels and sizes.
• CABG was successfully performed using only saphenous vein grafts due to the condition of other arteries.

Implications:

• The case underscores the importance of considering syphilis in the differential diagnosis of atherosclerosis, particularly in patients with CAD and no identifiable risk factors.
• Preoperative evaluation for connective tissue disorders, chronic inflammatory conditions, and cold hemagglutinins is recommended for patients with unexplained CAD and potential aortic disease.
• This emphasizes the need for comprehensive preoperative assessments to ensure patient safety, especially when deep hypothermia or circulatory arrest might be necessary during surgery.