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Internal mammary artery steal in a dialysis patient
Hiroshi Kato1, Seiichiro Ikawa, Akio Hayashi
1Division of Cardiovascular Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
Insights
Patients on dialysis with arteriovenous fistulas may experience internal mammary artery steal syndrome. Preoperative internal mammary artery angiography is recommended to prevent complications during coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Diagnostic Imaging
Background:
- The patient, a 67-year-old male with chronic renal failure undergoing dialysis via an arteriovenous fistula, was scheduled for off-pump coronary artery bypass grafting.
- Dialysis access, particularly arteriovenous fistulas, is common in patients with end-stage renal disease requiring cardiac surgery.
Observation:
- Intraoperative angiography revealed a steal phenomenon in the left internal mammary artery during diastole.
- This steal phenomenon was localized to the left internal mammary artery.
Findings:
- Postoperative Doppler guidewire studies confirmed that the left internal mammary artery steal was caused by the ipsilateral arteriovenous fistula.
- The arteriovenous fistula was identified as the source of the steal phenomenon affecting the internal mammary artery.
Implications:
- Preoperative screening of the internal mammary artery using angiography is crucial for dialysis patients.
- This screening can help identify and mitigate the risk of internal mammary artery steal syndrome before cardiac surgery.
- Implementing routine preoperative angiography may improve surgical outcomes and patient safety in this vulnerable population.
Abstract:
A 67-year-old man with chronic renal failure who was being treated with dialysis through an arteriovenous fistula in the left arm was scheduled to undergo off-pump coronary artery bypass grafting. Angiography detected the steal phenomenon in the left internal mammary artery during the diastolic phase. Postoperative study with Doppler guidewire showed that the steal of the left internal mammary artery was due to an ipsilateral arteriovenous fistula. Preoperative angiography of the internal mammary artery is therefore recommended for patients on dialysis.
