Internal thoracic artery as a collateral source to the ischemic lower extremity

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• The internal thoracic artery (ITA) is a preferred conduit for coronary artery bypass grafting (CABG) due to excellent long-term patency.
• Chronic limb ischemia (CLI) often requires complex revascularization strategies.
• The potential dual role of the ITA in supplying both the myocardium and lower limbs is not widely recognized.

Observation:

• Two cases are presented where patients required simultaneous revascularization of the myocardium and chronically ischemic lower limbs.
• The internal thoracic artery was identified as a potential collateral source to the ischemic lower limbs in these patients.
• Selective angiography of the ITA was performed preoperatively to assess its collateral function.

Findings:

• The internal thoracic artery successfully served as a collateral source to the lower limbs in the presented cases.
• Simultaneous revascularization of the myocardium and lower limbs using the ITA was technically feasible.
• Preoperative selective angiography of the ITA was instrumental in determining its viability as a collateral source.

Implications:

• The internal thoracic artery can be a valuable option for simultaneous myocardial and lower limb revascularization in select patients.
• This approach may offer an alternative for patients with complex coronary and peripheral artery disease.
• Careful preoperative evaluation, including selective ITA angiography, is essential to identify suitable candidates and avoid potential vascular complications.