[A difficult case of antiphospholipid syndrome with repeated restenosis of coronary artery and grafts].
A 65-year-old man complained of exertional angina. Coronary angiography revealed 99% stenosis in the left anterior descending artery (LAD). He underwent percutaneous transluminal coronary angioplasty (PTCA) and stenting. Repeat angiography demonstrated restenosis of the previous PTCA and stenting site. He underwent coronary artery bypass grafting (CABG) with placement of the left internal thoracic artery (LITA) to LAD. Chest discomfort and V1-V3 ST elevation appeared on the first post operative day. Coronary angiography revealed occlusion of the LITA graft. He underwent re-operation. Because the radial artery was severely sclerotic, the great saphenous vein was used for the graft. Two weeks later, he began to show edema in the left lower extremity. Echoangiogram showed occlusion of the left deep vein with thrombus. He tested positive for anticardiolipin IgG and IgM antibodies. Eighteen months after re-operation, he had recurrent chest discomfort on exertion. Coronary angiography revealed 90% stenosis of the anastomosis (SVG-LAD). A second re-operation was performed. We used the right internal thoracic artery (RITA) for the graft. The postoperative angiography showed patent graft. The patient has been doing well without any complications.
Kurushima
A
A
Department of Cardiovascular Surgery, National Zentsuji Hospital, Zentsuji, Japan.
Fukata
Y
Y
Horike
K
K
Kanoh
M
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016736:Antiphospholipid Syndrome / Q000601:surgery*; D023921:Coronary Stenosis / Q000601:surgery; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D014654:Vascular Patency