Right internal thoracic artery remodeling 18 years after circumflex system grafting

Area of Science:

• Cardiovascular Surgery
• Vascular Biology
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) management often involves myocardial revascularization using arterial grafts.
• The left internal thoracic artery (LITA) and right internal thoracic artery (RITA) are commonly used for coronary artery bypass grafting (CABG).
• Long-term graft patency and adaptive remodeling are critical for sustained myocardial blood flow.

Observation:

• A 64-year-old male with left main coronary artery disease (CAD) underwent CABG with LITA to the left anterior descending artery and RITA to the obtuse marginal artery.
• Eighteen years post-CABG, the patient experienced recurrent angina due to occluded native coronary arteries and left subclavian artery.
• A patent RITA graft was found to be maintaining cardiac blood supply, exhibiting increased lumen diameters indicative of remodeling.

Findings:

• The RITA graft demonstrated significant long-term patency and flow-dependent remodeling.
• The LITA graft was disconnected and repurposed as a free graft to the aorta to restore myocardial perfusion.
• This case illustrates the potential for arterial grafts to adapt and maintain function over extended periods.

Implications:

• Utilizing live arterial grafts, such as the RITA, offers durable long-term patency in coronary revascularization.
• Flow-dependent remodeling of arterial grafts contributes to sustained graft function and myocardial blood supply.
• This case supports the strategy of using internal thoracic artery grafts for robust, long-lasting outcomes in complex CAD.
• Repurposing grafts, like the LITA in this instance, can be a viable option for restoring myocardial blood flow when primary grafts fail or require modification.