Recurrent cellulitis after saphenous venectomy for coronary bypass surgery

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Dermatology

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure.
• Saphenous vein harvesting is a standard component of CABG.
• Potential complications of CABG are well-documented, but new ones can emerge.

Observation:

• A series of five patients experienced recurrent acute cellulitis episodes.
• Episodes consistently occurred in the lower extremity where saphenous venectomy was performed.
• Patients presented with high fever and significant systemic toxicity.

Findings:

• The cellulitis episodes suggest a group A streptococcal infection.
• Clinical presentation included characteristic skin lesions and, in one case, lymphangitis.
• A beta-hemolytic, bacitracin-susceptible Streptococcus strain was isolated from a lesion.
• Prompt response to penicillin therapy in some cases supports a bacterial etiology.

Implications:

• This study identifies recurrent cellulitis as a previously unreported complication of CABG.
• The pathogenesis likely involves compromised lymphatic drainage, bacterial invasion, and hypersensitivity.
• Understanding this complication is crucial for patient management and preventative strategies post-CABG.