Ruptured mycotic reverse saphenous vein graft aneurysm: A late complication of mediastinitis.

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as the patient suffered ventricular arrhythmia for which cardiopulmonary resuscitation (CPR) was done. After CPR, haematoma appeared on the left side of the sternum subcutaneously. CT scan of the chest was conducted which showed a pseudoaneurysm measuring 35 mm in the mid-segment of reverse saphenous vein graft (RSVG) to the right posterior descending artery (RPDA) with a surrounding mediastinal haematoma communicating with subcutaneous haematoma, so RSVGA to RPDA was coiled. As blood culture grew candida, antifungal medication was started. When the patient's condition stabilised he was discharged.

Delay between onset of indication and definitive surgery for tracheal trauma.

Tracheal stenosis is rare but a recognized complication after traumatic injury or prolonged intubation. We assessed the time lag between onset of indication for tracheal reconstruction surgery following trauma and actual surgical intervention. We reviewed our operative records for all patients undergoing tracheal reconstruction over the past 10 years. Files were reviewed retrospectively to collect all the relevant data. Surgically all patients were operated via cervical approach. Series 12 cases were identified with an equal split between external trauma and iatrogenic tracheal trauma from prolonged intubation. On, an average patients presented 185 days after initial indication of surgery however there was a wide range of time lag which leads to the importance of early diagnosis of such injuries to reduce delay of definitive management.