| Off-Pump CABG and Ligation for
Coronary Artery Pseudoaneurysm Occurring during the Chronic Post-PTCA
Period |
| Keiji Oi |
Toshiyuki Maruyama |
（Department of Surgery, Cardiovascular Center,
Yokosuka Kyosai General Hospital, Yokosuka, Japan)
|
Pseudoaneurysm after the rupture
of a coronary artery is a rare complication of percutaneous transluminal
coronary angioplasty（PTCA). We report a pseudoaneurysm of the
left anterior descending artery（LAD）occurring 3 months post-PTCA,
that was successfully treated by off-pump coronary artery bypass
grafting（CABG）and ligation. An 84-year-old man underwent urgent
PTCA for unstable angina. The LAD ruptured during this procedure,
but bail-out was successfully performed by balloon catheter inflation.
The patient left the hospital symptom-free. Three months later,
he was rehospitalized complaining of angina. Coronary angiography
revealed a 10-mm diameter pseudoaneurysm at the site of the LAD
rupture as well as restenosis of the LAD and high lateral branch
at the previous PTCA sites. Surgical treatment was indicated
because of the difficulty in delivering a covered stent within
the diffusely stenosed LAD. CABG to the distal LAD with the left
internal mammary artery and ligation of the LAD pseudoaneurysm
were performed. To reduce perioperative morbidity, CABG was performed
without cardiopulmonary bypass. The postoperative course was
uneventful, and follow-up angiography revealed a patent graft
and no pseudoaneurysm. The patient has continued comfortably
for 18 months postoperatively. Because off-pump CABG is less
invasive than conventional surgery techniques, we believe it
to be a valid option during coronary pseudoaneurysm ligation.
Jpn. J. Cardiovasc. Surg. 31: 296-299 (2002) |
|
