[Kinking of skeletonized internal thoracic artery graft]

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Biology

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure to restore blood flow to the heart.
• Internal thoracic arteries (ITAs), specifically the right (RITA) and left (LITA), are frequently used as grafts to the left anterior descending (LAD) artery.
• Graft kinking is a potential complication that can affect graft patency and cardiac function.

Observation:

• Two cases of CABG are presented: a 66-year-old woman with RITA-LAD anastomosis and a 74-year-old man with LITA-LAD anastomosis.
• Postoperative angiography revealed kinking in both RITA and LITA grafts.
• The patient with LITA kinking experienced chest pain during hemodialysis, with subsequent angiography showing moderate stenosis and later antero-apical akinesis.

Findings:

• Graft kinking in CABG can persist long-term without significant changes in graft morphology or left ventricular function in some instances.
• In one case, LITA graft kinking was associated with moderate stenosis and, over time, led to antero-apical akinesis, suggesting myocardial viability loss.
• The steal phenomenon during hemodialysis may exacerbate the effects of LITA graft kinking.

Implications:

• Graft kinking is a critical factor to monitor post-CABG, especially in patients with comorbidities like chronic renal failure undergoing hemodialysis.
• The findings highlight the potential for graft kinking to compromise myocardial perfusion and viability, necessitating careful graft selection and postoperative surveillance.
• Further research is warranted to understand the mechanisms behind graft kinking and develop strategies to prevent or manage this complication effectively.