Acute postoperative graft phlebitis: A rare cause of saphenous vein-coronary artery bypass failure

Most graft occlusions occurring early after saphenous vein coronary artery bypass procedures result from technical problems at the graft to coronary artery anastomosis site. This report describes an unusual cause of graft occlusion in a 67-year-old man who died three weeks after operation—a postoperative acute phlebitis of an implanted saphenous vein graft. Infection in the graft wall resulted in isolated graft thrombosis in the setting of a patent anastomosis. Graft phlebitis in this patient was associated with a purulent pericarditis and mediastinitis which failed to respond to surgical débridement and antibiotic therapy. Although mediastinitis is not infrequent, infection of an implanted saphenous vein coronary artery bypass graft in association with mediastinitis has never been reported. The findings in our case show that such graft infection may occur, and may result in graft thrombosis and occlusion.