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Ulnar artery graft for myocardial revascularization
1Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Insights
This study reports the first use of an ulnar artery graft for coronary artery bypass grafting in Japan. The procedure successfully treated severe coronary artery disease in a patient with multiple comorbidities.
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.
Abstract:
We present a 60-year-old man who underwent coronary artery bypass grafting using an ulnar artery as one of the grafts intended to release angina pectoris. Previously, his right leg had been amputated following a traffic accident. The blood supply of his left leg was reduced due to atherosclerotic stenotic change (left ankle pressure index 0.6). He had been under treatment for severe diabetes mellitus for 4 years. Coronary angiography revealed severe stenosis in the triple coronary artery system. Immediate myocardial revascularization was considered necessary. We considered that saphenous vein grafts and bilateral internal thoracic artery grafts were unsuitable for this patient. Moreover, Allen's test was positive in the bilateral forearms. Coronary artery bypass surgery consisted of left internal thoracic artery grafting to the left anterior descending artery, right gastroepiploic artery grafting to the right coronary artery, and left ulnar artery grafting to the diagonal branch. No myocardial or hand complications were observed after surgery. Following a review of the Japanese literature, we conclude that our case is the first report of an ulnar artery graft for coronary artery bypass grafting in Japan.