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CC BY 4.0 · TH Open 2020; 04(03): e197-e202
DOI: 10.1055/s-0040-1715657
Case Report

Intraoperative Thrombophilia-Associated Thrombosis of Both Saphenous Veins during Harvesting for Coronary Artery Bypass Grafting

Piotr Mazur 
1   Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
2   Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland
,
Michał Ząbczyk
1   Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
2   Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland
,
Radosław Litwinowicz
1   Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
2   Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland
,
Joanna Natorska
1   Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
2   Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland
,
Bogusław Kapelak
1   Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
2   Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland
› Author Affiliations Funding This study was funded by a grant from the Jagiellonian University Medical College (no.: K/ZDS/007961 to P.M.).
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Abstract

Introduction Intraoperative thrombosis of saphenous veins (SV) during open harvesting is very rare.

Case Report We present a case of a 60-year-old male patient with multivessel coronary artery disease and a history of a non-ST elevation acute coronary syndrome, and type-2 diabetes mellitus admitted for coronary artery bypass grafting, in whom bilateral intraoperative SV thrombosis occurred during graft harvesting. Routine thrombophilia screening showed no abnormalities and cancer was excluded. Compared with healthy controls, we observed prolonged fibrin clot lysis time and increased thrombin generation reflected by endogenous thrombin potential. Scanning electron microscopy of the thrombosed material revealed compact and thick fibrin layer on the clot surface with a solid mass of unusually compressed platelets and erythrocytes underneath. The patient was tested for fibrinogen and factor (F) XIII polymorphisms, and was found to be heterozygous for β-fibrinogen HaeIII (-455G > A) and FXIII Val34Leu (100G > T).

Conclusion β-fibrinogen HaeIII and FXIII Val34Leu polymorphisms are reflected in reduced clot permeability and susceptibility to lysis, and might contribute to intraoperative SV thrombosis during vascular grafting procedures. Carriers of those are at risk of primary venous graft failure after bypass procedures.

Keywords

coronary artery bypass grafting - thrombosis - fibrin - fibrinogen - mutation


Publication History

Received: 11 March 2020

Accepted: 13 July 2020

Article published online:
23 August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Bourassa MG. Fate of venous grafts: the past, the present and the future. J Am Coll Cardiol 1991; 17 (05) 1081-1083
    CrossrefPubMedGoogle Scholar
  • 2 Roubos N, Rosenfeldt FL, Richards SM, Conyers RA, Davis BB. Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting. Circulation 1995; 92 (09) II31-II36
    CrossrefPubMedGoogle Scholar
  • 3 Mazur P, Sokołowski G, Hubalewska-Dydejczyk A, Płaczkiewicz-Jankowska E, Undas A. Prothrombotic alterations in plasma fibrin clot properties in thyroid disorders and their post-treatment modifications. Thromb Res 2014; 134 (02) 510-517
    CrossrefPubMedGoogle Scholar
  • 4 Undas A, Zawilska K, Ciesla-Dul M. , et al. Altered fibrin clot structure/function in patients with idiopathic venous thromboembolism and in their relatives. Blood 2009; 114 (19) 4272-4278
    CrossrefPubMedGoogle Scholar
  • 5 Natorska J, Marek G, Hlawaty M, Sadowski J, Tracz W, Undas A. Fibrin presence within aortic valves in patients with aortic stenosis: association with in vivo thrombin generation and fibrin clot properties. Thromb Haemost 2011; 105 (02) 254-260
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Undas A, Szułdrzynski K, Stepien E. , et al. Reduced clot permeability and susceptibility to lysis in patients with acute coronary syndrome: effects of inflammation and oxidative stress. Atherosclerosis 2008; 196 (02) 551-557
    CrossrefPubMedGoogle Scholar
  • 7 Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996; 28 (03) 616-626
    CrossrefPubMedGoogle Scholar
  • 8 Kim FY, Marhefka G, Ruggiero NJ, Adams S, Whellan DJ. Saphenous vein graft disease: review of pathophysiology, prevention, and treatment. Cardiol Rev 2013; 21 (02) 101-109
    CrossrefPubMedGoogle Scholar
  • 9 Allaire E, Clowes AW. Endothelial cell injury in cardiovascular surgery: the intimal hyperplastic response. Ann Thorac Surg 1997; 63 (02) 582-591
    CrossrefPubMedGoogle Scholar
  • 10 McGeachie JK, Meagher S, Prendergast FJ. Vein-to-artery grafts: the long-term development of neo-intimal hyperplasia and its relationship to vasa vasorum and sympathetic innervation. Aust N Z J Surg 1989; 59 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 11 Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013; 257 (05) 824-833
    CrossrefPubMedGoogle Scholar
  • 12 Undas A. Fibrin clot properties and their modulation in thrombotic disorders. Thromb Haemost 2014; 112 (01) 32-42
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Undas A, Podolec P, Zawilska K. , et al. Altered fibrin clot structure/function in patients with cryptogenic ischemic stroke. Stroke 2009; 40 (04) 1499-1501
    CrossrefPubMedGoogle Scholar
  • 14 Undas A, Zalewski J, Krochin M. , et al. Altered plasma fibrin clot properties are associated with in-stent thrombosis. Arterioscler Thromb Vasc Biol 2010; 30 (02) 276-282
    CrossrefPubMedGoogle Scholar
  • 15 Goldman-Mazur S, Wypasek E, Karpiński M, Stanisz A, Undas A. High detection rates of antithrombin deficiency and antiphospholipid syndrome in outpatients aged over 50 years using the standardized protocol for thrombophilia screening. Thromb Res 2019; 176: 67-73
    CrossrefPubMedGoogle Scholar
  • 16 Moor E, Hamsten A, Blombäck M, Herzfeld I, Wiman B, Rydén L. Haemostatic factors and inhibitors and coronary artery bypass grafting: preoperative alterations and relations to graft occlusion. Thromb Haemost 1994; 72 (03) 335-342
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279 (18) 1477-1482
    CrossrefPubMedGoogle Scholar
  • 18 de Maat MP, Kastelein JJ, Jukema JW. , et al. -455G/A polymorphism of the beta-fibrinogen gene is associated with the progression of coronary atherosclerosis in symptomatic men: proposed role for an acute-phase reaction pattern of fibrinogen. REGRESS group. Arterioscler Thromb Vasc Biol 1998; 18 (02) 265-271
    CrossrefPubMedGoogle Scholar
  • 19 Gu L, Liu W, Yan Y. , et al. Influence of the β-fibrinogen-455G/A polymorphism on development of ischemic stroke and coronary heart disease. Thromb Res 2014; 133 (06) 993-1005
    CrossrefPubMedGoogle Scholar
  • 20 Hu X, Wang J, Li Y. , et al. The β-fibrinogen gene 455G/A polymorphism associated with cardioembolic stroke in atrial fibrillation with low CHA2DS2-VaSc score. Sci Rep 2017; 7 (01) 17517
    CrossrefPubMedGoogle Scholar
  • 21 Jung JH, Song GG, Kim JH, Seo YH, Choi SJ. Association of factor XIII Val34Leu polymorphism and coronary artery disease: a meta-analysis. Cardiol J 2017; 24 (01) 74-84
    CrossrefPubMedGoogle Scholar
  • 22 Li B, Heldner MR, Arnold M. , et al. Coagulation Factor XIII in Cerebral Venous Thrombosis. TH Open 2019; 3 (03) e227-e229
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Jung JH, Kim JH, Song GG, Choi SJ. Association of the F13A1 Val34Leu polymorphism and recurrent pregnancy loss: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2017; 215: 234-240
    CrossrefPubMedGoogle Scholar
  • 24 Shemirani AH, Pongrácz E, Antalfi B, Adány R, Muszbek L. Factor XIII A subunit Val34Leu polymorphism in patients suffering atherothrombotic ischemic stroke. Thromb Res 2010; 126 (02) 159-162
    CrossrefPubMedGoogle Scholar
  • 25 Shemirani AH, Antalfi B, Pongrácz E, Mezei ZA, Bereczky Z, Csiki Z. Factor XIII-A subunit Val34Leu polymorphism in fatal atherothrombotic ischemic stroke. Blood Coagul Fibrinolysis 2014; 25 (04) 364-368
    CrossrefPubMedGoogle Scholar
  • 26 Kreutz RP, Bitar A, Owens J. , et al. Factor XIII Val34Leu polymorphism and recurrent myocardial infarction in patients with coronary artery disease. J Thromb Thrombolysis 2014; 38 (03) 380-387
    CrossrefPubMedGoogle Scholar
  • 27 Stepień E, Plicner D, Kapelak B, Wypasek E, Sadowski J, Undas A. Factor XIII Val34Leu polymorphism as a modulator of fibrin clot permeability and resistance to lysis in patients with severe coronary artery disease. Kardiol Pol 2009; 67 (8A): 947-955
    PubMedGoogle Scholar