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Involvement of the coronary artery in a patient with thromboangiitis obliterans. A case report

Necip Becit1, Yahya Unlü, Hikmet Koçak

  • 1Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey. necipbecit@hotmail.com

Heart and Vessels
|August 16, 2002
PubMed

Insights

This case study details successful coronary artery bypass grafting (CABG) in a young patient with Buerger's disease and acute myocardial infarction. The complex procedure involved endarterectomy and bypass to the left anterior descending artery and right coronary artery.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Buerger's disease, also known as thromboangiitis obliterans, is a rare inflammatory condition affecting small and medium-sized arteries, predominantly in the limbs.
  • Acute myocardial infarction (MI) in young adults is uncommon and necessitates thorough etiological investigation.
  • Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease, but its application in patients with Buerger's disease presents unique challenges.

Observation:

  • A 36-year-old male with a history of bilateral lumbar sympathectomy for thromboangiitis obliterans presented with acute myocardial infarction.
  • Coronary angiography revealed critical occlusions in the left anterior descending artery (LAD) and right coronary artery, with significant left ventricular dysfunction.
  • Histopathological examination of the endarterectomy specimen confirmed features consistent with thromboangiitis obliterans.

Findings:

  • Successful surgical management of acute myocardial infarction in a patient with Buerger's disease using coronary artery bypass grafting (CABG).
  • The surgical strategy included endarterectomy and complex bypass to the left anterior descending artery (LAD) utilizing the left internal mammary artery (LIMA), and an aorta-right coronary artery saphenous vein bypass.
  • The patient experienced an uneventful postoperative recovery and was discharged on the ninth day.

Implications:

  • This case highlights the feasibility and successful outcome of CABG in young patients with Buerger's disease presenting with acute myocardial infarction.
  • It underscores the importance of considering Buerger's disease in the differential diagnosis of arterial occlusive disease in young individuals.
  • The successful surgical intervention suggests that aggressive revascularization strategies can be beneficial even in the presence of complex vascular pathology like thromboangiitis obliterans.

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