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Limb ischemia due to use of internal thoracic artery in coronary bypass
Fikri Yapici1, Aybanu G Tuygun, Ibrahim A Tarhan
1Department of Cardiovascular Surgery Siyami Ersek Thoracic and Cardiovascular Surgery Center Istanbul, Turkey. fyapici@turk.net
Insights
Coronary bypass surgery can rarely lead to leg ischemia. Prompt intervention with bypass grafting successfully resolved symptoms in one patient, while another required no treatment for arterial stenosis.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure to improve blood flow to the heart.
- The left internal thoracic artery (LITA) is frequently used as a graft in CABG due to its long-term patency rates.
- Postoperative complications, though rare, can occur and require prompt diagnosis and management.
Observation:
- A 59-year-old male patient experienced acute left leg ischemia immediately following CABG with LITA.
- A 72-year-old male patient presented with left calf pain 12 days after a similar procedure.
- Peripheral angiography was performed in the second patient to investigate the cause of calf pain.
Findings:
- The first patient's leg ischemia resolved completely after a right-to-left femoral artery crossover bypass.
- The second patient's angiography revealed stenosis in the abdominal aorta and distal peripheral arteries.
- The arterial stenosis identified in the second patient did not necessitate surgical or endovascular intervention.
Implications:
- This case series highlights the potential for lower limb ischemia as a rare complication after CABG.
- Prompt recognition and appropriate surgical intervention, such as femoral artery bypass, can effectively treat acute ischemia.
- Non-invasive assessment of peripheral vasculature is crucial for identifying underlying stenosis that may not require immediate intervention but warrants monitoring.
Abstract:
Immediately after undergoing coronary bypass grafting using the left internal thoracic artery, a 59-year-old man developed left leg ischemia. Right-to-left femoral artery crossover bypass was performed and the ischemia resolved. A 72-year-old man developed left calf pain 12 days after a similar procedure; peripheral angiography revealed stenosis of the abdominal aorta and distal peripheral arteries, which did not require intervention.