The first case of surgical myocardial revascularization and endarterectomy of the right carotid artery in the same procedure in a patient with haemophilia A

Vojnosanitetski Pregled

Mikić Aleksandar¹  Janković Nataša²  Matković Miloš²  Simić Dragan³  Vukičević Petar⁴  Elezović Ivo⁵ 

[1] Clinical Center of Serbia, Department of Cardiac Surgery, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia;Clinical Center of Serbia, Department of Cardiac Surgery, Belgrade, Serbia;Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia;Military Medical Academy, Clinic for Cardiac Surgery, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Department of Hematology, Belgrade, Serbia;

关键词: hemophilia a;    coronary disease;    coronary artery bypass;    endarterectomy, carotid;    cardiovascular surgical procedures;    treatment outcome;   

DOI  :  10.2298/VSP181010006J

来源: DOAJ

【 摘 要 】

Introduction. Haemophilia A is the most common hereditary coagulation disturbance occurring due to the lack of coagulation factor VIII. It is widely accepted that people with haemophilia have a reduced incidence of coronary artery disease, potentially because of the protective effect of the impaired coagulation against the pathogenic mechanisms of the acute coronary syndrome. Case report. A 53-year-old man with mild haemophilia [FVIII 22% (mild form: more than 5%–40% of normal)] was hospitalized because of frequent anginal pain at rest. Selective coronary angiography revealed a severe three-vessel coronary disease. A need for urgent surgical revascularization was indicated. The color duplex scan showed the existence of hemodynamically significant stenosis on the right internal carotid artery. After consulting a haematologist, a cardiac surgeon, and a vascular surgeon, it was concluded that due to high bleeding risk, the patient should undergo an endarterectomy of the right carotid artery and a triple aortocoronary bypass in the same procedure. Procedures were performed with a substitution of FVIII concentrate. The patient firstly underwent the endarterectomy of the right carotid artery. Then, the left mammary artery graft was implanted to the left anterior descending artery as well as the venous grafts to the first obtuse marginal artery and posterior descending branch. There were no complications. During the revascularization, there was no need for blood transfusion, nor was there excessive bleeding in the postoperative period. The patient was discharged with antithrombotic therapy (aspirin, 50 mg). Conclusion. Patients with haemophilia are not protected against the development of atherosclerosis. Cardiac surgery in these patients presents a unique challenge for medical teams in securing haemostasis. Adequate substitution with factor VIII concentrate provides adequate haemostasis and the possibility for treatment with antiplatelet therapy.

【 授权许可】

Unknown