Anterior Descending Coronary Artery Pseudoaneurysm in an 85-Year-Old Male Hemodialysis Patient: A Surgical Case Report

Abstract

Patient: Male, 85-year-old Final Diagnosis: Coronary artery pseudoaneurysm Symptoms: Chest pain Clinical Procedure: Aneurysmectomy and coronary artery bypass grafting Specialty: Cardiac Surgery Objective: Rare disease Background: Coronary artery pseudoaneurysm is an extremely rare condition. In this report, we describe an 85-year-old he-modialysis male patient who developed a coronary artery pseudoaneurysm due to physical damage associat-ed with coronary artery calcification. Case Report: An 85-year-old man on hemodialysis had undergone emergency percutaneous coronary intervention of the left anterior descending artery for acute coronary syndrome 9 years ago. He presented to the emergency room with a fever and chest pain and was admitted to the cardiology department with a urinary tract infection and acute coronary syndrome. On day 21 after admission, when the urinary tract infection had resolved, coronary angiog-raphy was performed, which revealed a pseudoaneurysm proximal to the left anterior descending artery stent. The patient was scheduled to undergo surgery due to the pseudoaneurysm’s risk of rupture. Surgical manipu-lation was performed under cardiac arrest using the median sternotomy approach. A highly calcified coronary intima was found inside the pseudoaneurysm, which was completely ruptured on the proximal side of the pseu-doaneurysm. The pseudoaneurysm was closed after endarterectomy. A coronary artery bypass graft was also performed in the great saphenous vein graft of the left anterior descending artery. Histopathological examina-tion showed no obvious signs of infection, and a diagnosis of pseudoaneurysm was established. Postoperative contrast-enhanced computed tomography showed patency of the coronary artery bypass graft and no pseu-doaneurysm recurrence. Conclusions: Coronary artery pseudoaneurysms are extremely rare, but this case demonstrates that atherosclerotic changes can lead to the formation of a pseudoaneurysm in an elderly hemodialysis patient.