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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
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[Late occlusion of the subclavian artery proximal to mammary bypass]

S Fukui1, E Chelbi, N Paraskevas

  • 1Service de Chirurgie Vasculaire, Foundation-Hôpital Saint-Joseph, Paris. sumio_fukui@yahoo.com

Archives Des Maladies Du Coeur Et Des Vaisseaux
|October 20, 2005
PubMed

Insights

Left internal mammary artery bypasses are effective, but proximal subclavian artery occlusion can cause myocardial ischemia. Re-implantation relieved symptoms, highlighting the need for surveillance of bypass grafts.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Internal mammary artery (IMA) grafts are preferred for coronary artery bypass grafting (CABG) due to resistance to atherosclerosis.
  • Proximal subclavian artery (SCA) lesions can compromise flow in IMA grafts used for coronary revascularization.

Observation:

  • Two patients developed left SCA occlusion years after left IMA to anterior interventricular artery bypass.
  • Myocardial ischemia was detected via scintigraphy in one patient and presented as exertional angina in the upper limb in the other.

Findings:

  • Re-implantation of the occluded SCA into the common carotid artery successfully resolved myocardial ischemia in both patients.
  • Proximal SCA stenosis or occlusion poses a risk to the myocardial territory revascularized by an IMA graft.

Implications:

  • While IMA grafts are durable, the proximal SCA feeding the graft is susceptible to atherosclerotic disease.
  • Regular clinical evaluation and ultrasound surveillance are crucial for detecting proximal SCA lesions in patients with IMA bypass grafts.

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