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Internal thoracic artery as a collateral source to the ischemic lower extremity
N Hayashida1, E Kai, N Enomoto
1Department of Surgery, Kurume University, 67 Asahi-machi, 830-0011, Kurume, Japan. nobuhiko@med.kurume-u.ac.jp
Insights
The internal thoracic artery, commonly used for heart bypass surgery, can also supply blood to ischemic lower limbs. Surgeons can perform simultaneous revascularization for both conditions, but careful pre-operative assessment is crucial.
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.
Abstract:
Based on the superior long-term results, internal thoracic artery is widely used for coronary artery bypass grafting. However, the vessel can play an important role as a collateral source to the chronically ischemic lower limbs. We reported two cases who underwent simultaneous revascularization to the myocardium and lower limbs because this particular condition was anticipated. Selective angiography of internal thoracic artery was useful to determine its role before harvesting in our cases. Careful preoperative examinations and choice of surgical approach are required for such patients to avoid serious vascular complications.