[Coronary artery bypass graft stenosis suspected to be due to hemostatic agents: a case report].
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.
Tomizawa
Y
Y
Department of Cardiovascular Surgery, Tokyo Women's Medical College.
Endo
M
M
Kitamura
M
M
Shiikawa
A
A
Yagi
Y
Y
Koyanagi
H
H
D000368:Aged; D002483:Cellulose, Oxidized / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000601:surgery; D006488:Hemostasis, Surgical / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012086:Reoperation
D002483:Cellulose, Oxidized; D015718:Fibrin Tissue Adhesive