title: Percutaneous saphenectomy: a potentially dreadful complication of cutting balloon angioplasty in saphenous vein grafts.
abstract: Vessel perforation is an uncommon but potentially life-threatening complication of percutaneous coronary intervention and is often associated with the use of atheroablative devices. While effective management means are currently available, such as PTFE-covered stent, pericardiocentesis, and perfusion balloon, a timely and skillful approach is of paramount importance to solve this dreadful complication. We hereby describe a case of saphenous vein graft (SVG) perforation occurring after cutting balloon angioplasty for in-stent restenosis. Despite the immediate occurrence of cardiac arrest due to massive extravasation of contrast in the mediastinum with pericardial tamponade, deep catheter intubation enabled the deployment of two PTFE-covered stents and subsequent sealing of the leak with repeated inflation of a perfusion balloon, while hemopericardium was drained by pericardiocentesis. This clinical vignette emphasizes the role of optimal backup in order to deploy life-saving devices and successfully manage life-threatening pericardial tamponade due to SVG rupture.
authors.forename: Worawut
authors.initials: W
authors.lastname: Tassanawiwat
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Eleutheria
authors.initials: E
authors.lastname: Tsagalou
authors.forename: Gloria
authors.initials: G
authors.lastname: Melzi
authors.forename: Lei
authors.initials: L
authors.lastname: Ge
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: Nicola
authors.initials: N
authors.lastname: Corvaja
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017073:Atherectomy / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D002305:Cardiac Tamponade / Q000209:etiology* / Q000628:therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D012501:Saphenous Vein / Q000293:injuries* / Q000637:transplantation; D015607:Stents