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Doppler features of occlusion of the internal thoracic artery due to preoperative branch embolization
1The Second Department of Surgery, Nihon University, School of Medicine, Tokyo, Japan.
Insights
Preoperative embolization of a left internal thoracic artery (LITA) branch led to thrombus formation and graft occlusion. Altered Doppler waveforms in the LITA successfully diagnosed this unexpected complication.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Imaging
Background:
- A 61-year-old male with unstable angina and 3-vessel disease underwent evaluation for coronary artery bypass grafting.
- Preoperative arteriography identified a significant branch of the left internal thoracic artery (LITA).
Observation:
- Selective arterial embolization of the LITA branch was performed preoperatively.
- Post-embolization, LITA Doppler peak flow velocity and diameter increased.
- A novel reverse wave was detected in the LITA Doppler waveform after embolization.
Findings:
- Intraoperative examination revealed LITA occlusion at the second intercostal space due to thrombus.
- The patient subsequently received a right internal thoracic artery to left anterior descending artery bypass and reversed saphenous vein grafts.
Implications:
- This case highlights a unique preoperative complication of LITA branch embolization.
- Altered Doppler waveform analysis proved crucial for diagnosing graft-related issues.
- This finding may inform future interventional strategies and graft monitoring.
Abstract:
A 61-year-old male was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with 3-vessel disease. On preoperative left internal thoracic arteriography, a large first intercostal branch was found at the proximal portion. Selective arterial embolization of the branch of the left internal thoracic artery (LITA) was carried out preoperatively. At 2 days after embolization, the Doppler peak flow velocity and diameter of the LITA were increased and enlarged compared with before the procedure. However, a large reverse wave following after the first systolic peak flow of the LITA was newly detected after embolization. Upon operation, the LITA was found to be occluded at the 2nd intercostal space due to thrombus formation. Therefore, the right internal thoracic artery was anastomosed to the left anterior descending artery and coronary reversed saphenous vein grafts were joined to segment 4PD of the right coronary artery. The postoperative course was uneventful. There has been no previous report of an LITA branch being embolized preoperatively. It was possible to diagnose the graft problem by detecting the altered Doppler wave form of the LITA.