Breast infarction due to calciphylaxis after coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Dermatopathology

Background:

• Coronary artery bypass grafting (CABG) frequently utilizes the internal mammary artery (IMA).
• Calciphylaxis is a rare but severe condition causing skin necrosis due to vascular calcification, often seen in end-stage renal disease.
• Chronic renal insufficiency (CRI) without dialysis is a less common risk factor for calciphylaxis.

Observation:

• A patient with CRI, not on dialysis, developed breast necrosis post-CABG.
• The necrosis was linked to internal mammary artery harvesting.
• Histopathology revealed mural vascular calcification and intimal proliferation in breast vasculature.

Findings:

• The patient's breast necrosis was attributed to calciphylaxis.
• Histological findings confirmed calciphylaxis affecting small to medium-sized vessels in the breast tissue.
• This led to ischemic skin necrosis and septal panniculitis.

Implications:

• This case highlights calciphylaxis as a potential complication of IMA harvesting in CRI patients, even without dialysis.
• It underscores the importance of considering calciphylaxis in patients with renal insufficiency presenting with unexplained necrosis post-surgery.
• Further research may be needed to elucidate the specific risks and mechanisms in non-dialysis CRI patients undergoing CABG.