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[Coronary artery bypass graft stenosis suspected to be due to hemostatic agents: a case report]
Y Tomizawa1, M Endo, M Kitamura
1Department of Cardiovascular Surgery, Tokyo Women's Medical College.
Insights
A rare granuloma, linked to oxidized cellulose hemostatic agents, formed in a coronary artery bypass graft (CABG). This rare complication caused graft stenosis and chest pain, necessitating surgical intervention and highlighting the need to discuss topical hemostatic agents.
Area of Science:
- Cardiovascular Surgery
- Surgical Pathology
- Biomaterials Science
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Topical hemostatic agents, such as oxidized cellulose and fibrin glue, are frequently used during CABG to control bleeding.
- Long-term complications associated with hemostatic agents are not well-documented.
Observation:
- A 66-year-old male patient developed recurrent graft stenosis and chest pain five years after undergoing CABG.
- Coronary angiography revealed a cyst near the proximal anastomosis of the saphenous vein graft.
- Microscopic examination of the resected cyst revealed a granuloma containing oxidized cellulose fibers within giant cells.
Findings:
- The patient's symptoms and graft stenosis were attributed to a granuloma formation.
- Oxidized cellulose, a component of the hemostatic agent used during the initial surgery, was identified within the granuloma.
- This represents a unique case report of granuloma formation secondary to oxidized cellulose in a CABG setting.
Implications:
- This case highlights a potential, albeit rare, long-term complication of using oxidized cellulose as a hemostatic agent in cardiovascular surgery.
- Further investigation into the biocompatibility and long-term effects of topical hemostatic agents in surgical settings is warranted.
- Clinicians should be aware of this potential complication when managing patients with complex graft issues post-CABG.
Abstract:
A 66-year-old man had a CABG with a saphenous vein graft. During the surgery, oxidized cellulose and fibrin glue were used and left in place for hemostasis. Six months after the surgery, the first postoperative CAG was performed and a stenosis of the coronary bypass graft near the proximal anastomosis was found. The first PTCA was done and the stenosis was released. Re-stenosis was observed at the same site one year after the first PTCA and a second one was performed. Five years and nine months after the surgery, the patient started complaining of severe chest pain even though he was receiving medication. Graft stenosis at the same site was observed by CAG. A cyst 3 cm in diameter, with irregular wall thickness was found near the proximal portion of the bypass graft. Resection of the cyst and re-CABG was performed uneventfully. Microscopically, the cyst consisted of fibroblasts, small vessels, collagen fiber and giant cells and was diagnosed as granuloma. In the giant cells, oxidized cellulose fiber was observed. No comparable cases have been reported in the literature. Topical hemostatic agents were discussed.