RESUMO
Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. Three previous reports have described ruptures of the SVC during venoplasty with death on one occasion. We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.
Assuntos
Angioplastia com Balão/efeitos adversos , Prótese Vascular/efeitos adversos , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Stents/efeitos adversos , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior/cirurgia , Adulto , Feminino , Traumatismos Cardíacos/diagnóstico , Humanos , Síndrome da Veia Cava Superior/complicações , Veia Cava Superior/lesõesRESUMO
True aneurysms of aortocoronary saphenous vein bypass grafts are a relatively rare complication of bypass surgery, but because the complications of thrombosis, embolization, or rupture are potentially fatal, this condition requires immediate surgical intervention. We describe a 78-year-old man who had undergone coronary bypass 15 years previously and who presented with a saphenous vein graft that was severely degenerated and aneurysmally enlarged throughout its course, measuring as much as 5 to 6 cm in certain locations. Redo coronary artery bypass grafting using the right and left internal thoracic arteries and resection of the aneurysm were performed. We also present a review of the literature regarding diagnosis, management, and treatment of this condition.