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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

Autoren

  • 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

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


Publikationsverlauf

Eingereicht: 11. März 2020

Angenommen: 13. Juli 2020

Artikel online veröffentlicht:
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/).

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