Background: Bilateral internal mammary arteries (BIMAs) remain underused in coronary artery bypass grafting (CABG), especially in elderly, diabetic, and obese patients. This study investigated incidence of sternal wound infection (SWI), sternal instability (SI), and reintervention for bleeding (RIB) in this high-risk population.
Methods: A single-center retrospective observational study was performed in "Grand Hôpital de Charleroi, Gilly, Belgium." A total of 319 patients undergoing CABG from December 2011 to December 2015 were included. Three main outcome measures (SWI, SI, and RIB) were investigated in obese vs nonobese, diabetic vs nondiabetic, and elderly vs younger patients.
Results: In all, 14 SWI, 11 SI, and 6 RIB were discounted. Death rate was as follows: SWI: 2/14 vs 17/305 (P = .178), SI: 2/11 vs 17/308 (P = .081), and RIB: 2/6 vs 17/313 (P = .004). In obese (n = 113) vs nonobese (n = 206) patients, there was no difference for SWI (P = .263), SI (P = .565), and RIB (P = .332). In diabetic (n = 118) vs nondiabetic (n = 201) patients, there was no difference for SWI (P = .642), SI (P = .497), and RIB (P = .298). In elderly (n = 62) vs younger (n = 257) patients, there was no difference for SWI (P = .619), SI (P = .915), and RIB (P = .385).
Conclusions: Obesity, age, and diabetes treated by insulin (or not) do not seem to be risk factors for developing SWI, SI, or RIB in patients receiving a CABG using BIMA. Nevertheless, mortality was higher in RIB group.
We presented an extremely rare case of a 38-year-old female's venous aneurysm of left cephalic vein with unique histopathological features, displaying variably thinned medial wall with focal, markedly reduced or absent smooth muscle cells and elastic fibers, most likely leading to the venous dissection with an intimal tear and many medial blood-filled vascular channels. We propose that those venous dissection-like findings would be a new feature especially from the clinicopathological viewpoints and might be considered in the classification of venous aneurysm. Further prospective studies are needed to validate the presence and significance of venous dissecting aneurysm as a new histopathological entity, after collecting and investigating a larger number of venous aneurysm cases examined. This short report could interest the scientific community, taken together with potentially specific findings of new entity, venous dissecting aneurysm.
Purpose: To report the endovascular reconstruction of the superior vena cava (SVC), innominate and internal jugular veins following stenosis due to mediastinal fibrosis.
Case report: A 36-year-old female with mediastinal fibrosis was referred for symptomatic SVC syndrome (SVCS). A covered stent was inserted in the SVC with 2 kissing stents in the innominate and jugular veins via anterograde right femoral vein access with sandwich technique. She exhibited near-immediate relief of debilitating symptoms. Computed tomographic scan demonstrated patent vessels at 1 year.
Conclusions: Extensive endovascular venous reconstruction is an effective treatment for SVCS due to mediastinal fibrosis.