Coronary revascularization with arterial conduits collateral to the lower limb

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for left main coronary artery disease.
• Iliac artery occlusion presents a significant challenge, often requiring complex revascularization strategies.
• Collateral circulation can provide alternative blood supply routes in cases of arterial stenosis or occlusion.

Observation:

• A 62-year-old male patient presented with left main coronary artery disease and total occlusion of the left common iliac artery.
• Angiography revealed well-developed collateral pathways via the left internal thoracic artery and left inferior epigastric artery to the left external iliac artery.
• These arterial conduits were identified as suitable for harvesting.

Findings:

• The patient underwent coronary artery bypass grafting.
• A concomitant femoro-femoral crossover bypass was performed.
• The left internal thoracic artery and left inferior epigastric artery were successfully harvested and grafted to the coronary artery, utilizing the collateral pathways.

Implications:

• This case demonstrates the feasibility of using arterial collateral pathways for complex coronary and iliac artery revascularization.
• The successful utilization of the internal thoracic and inferior epigastric arteries highlights their potential as conduits in challenging surgical scenarios.
• This approach may offer an alternative for patients with extensive arterial disease unsuitable for conventional bypass procedures.