Ulnar artery graft for myocardial revascularization

Area of Science:

• Cardiovascular Surgery
• Vascular Grafting
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease.
• Graft selection is critical, especially in patients with multiple risk factors and previous vascular issues.
• Alternative arterial conduits are sought when traditional grafts are unsuitable.

Observation:

• A 60-year-old male patient with severe triple-vessel coronary artery disease, diabetes mellitus, prior leg amputation, and peripheral artery disease was considered for CABG.
• Saphenous vein grafts and bilateral internal thoracic artery grafts were deemed unsuitable.
• Positive Allen's test in both forearms indicated potential compromised hand circulation.

Findings:

• Coronary artery bypass grafting was successfully performed using a left internal thoracic artery, a right gastroepiploic artery, and a left ulnar artery.
• The ulnar artery was utilized as a graft to the diagonal branch of the left coronary artery.
• No immediate myocardial or hand complications were observed post-surgery.

Implications:

• This case demonstrates the feasibility of using an ulnar artery graft in complex CABG scenarios.
• It expands the options for arterial conduits in patients with limited traditional graft availability.
• This represents the first reported use of an ulnar artery graft for CABG in Japan, contributing to the literature on vascular grafting techniques.