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. Hemophilia A is the most common hereditary coagulation disturbances 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 acute coronary syndrome. Case report. A 53-year-old man with a mild haemophilia (FVIII 22%) was hospitalized because of a frequent anginal pain at rest. Selective coronary angiography revealed a severe three-vessel coronary disease. A need for urgent surgical revascularization was indicated. Color duplex scan showed the existence of hemodynamically significant stenosis on the right internal carotid artery. After a consultation with a haematologist, a cardiac surgeon and a vascular surgeon, we 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 substitution of FVIII concentrate. The patient underwent implantation of left mammary artery graft to the LAD and venous grafts to the OM1 and PD branch alongside with the endarterectomy of the right carotid artery. There were no complications. During the revascularization there was no need for blood transfusion nor excessive bleeding in the postoperative period. The patient was discharged with antithrombotic therapy aspirin 50mg. Conclusion. Patients with haemophilia are not protected against development of atherosclerosis. Cardiac surgery in these patients presents a unique challenge to medical teams in securing haemostasis. Adequate substitution with factor VIII concentrate provides adequate haemostasis and possibility for treatment with antiplatelet therapy.

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