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Case Reports
. 2020 Aug 23;4(3):e197-e202.
doi: 10.1055/s-0040-1715657. eCollection 2020 Jul.

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

Piotr Mazur  1   2 , Michał Ząbczyk  1   2 , Radosław Litwinowicz  1   2 , Joanna Natorska  1   2 , Bogusław Kapelak  1   2
Affiliations
Case Reports

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

Piotr Mazur et al. TH Open. .

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; fibrin; fibrinogen; mutation; thrombosis.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Representative images of SV graft immunostaining after massive thrombosis ( A–D ) prothrombin stained red, TF stained green, nuclei stained blue using DAPI and scanning electron microscopic images ( E, F ) of the surface of whole blood clot formed in vitro from citrated blood obtained from the patient undergoing CABG. Box and arrow represent magnification of the fragment in the box. Arrows show pertinent stained fragments (see text). CABG, Coronary artery bypass grafting; SV, saphenous veins; TF, tissue factor.
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References

    1. Bourassa M G. Fate of venous grafts: the past, the present and the future. J Am Coll Cardiol. 1991;17(05):1081–1083. - PubMed
    1. Roubos N, Rosenfeldt F L, Richards S M, Conyers R A, Davis B B. Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting. Circulation. 1995;92(09):II31–II36. - PubMed
    1. 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. - PubMed
    1. Undas A, Zawilska K, Ciesla-Dul M. Altered fibrin clot structure/function in patients with idiopathic venous thromboembolism and in their relatives. Blood. 2009;114(19):4272–4278. - PubMed
    1. 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. - PubMed

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