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Internal thoracic artery as main blood supply to the lower limbs. Case report

A K Korkut1, G Cetin, K Suzer

  • 1Istanbul University, Haseki Cardiology Institute, Dept. of Cardiovascular Surgery, Istanbul, Turkey. kubilaykorkut@superonline.com

Acta Chirurgica Belgica
|June 10, 2006
PubMed

Insights

This case highlights the critical role of the internal thoracic artery (ITA) in supplying lower extremities in patients with severe coronary artery disease and Leriche syndrome. Preoperative assessment is vital for planning combined surgical approaches.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • A 70-year-old male presented with unstable angina pectoris and claudication.
  • Simultaneous critical left main and right coronary artery disease and juxtarenal aortic occlusion were diagnosed.

Observation:

  • The internal thoracic artery (ITA) showed increased diameter with collateral branches, suggesting it as a potential unique blood supply to the leg.
  • Coronary artery bypass graft (CABG) surgery was performed using saphenous veins, preserving the ITA to prevent lower extremity ischemia.

Findings:

  • Postoperative DSA confirmed the ITA as the sole blood supply to the leg.
  • A two-staged approach (CABG followed by aortobifemoral bypass) was considered but deemed insufficient for immediate needs.

Implications:

  • Combined surgical approaches are necessary for patients with severe peripheral vascular disease or those requiring postoperative intra-aortic balloon pump support.
  • Preoperative identification of ITA-dependent lower extremity circulation is crucial in coronary artery disease patients with Leriche syndrome.
  • Extra-anatomic peripheral bypass offers a low-morbidity alternative for combined procedures, particularly in elderly patients with comorbidities.

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