Related Experiment Video
Updated: Oct 10, 2025
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery
Ibrahim Mohsin1, Lalith Namburu2, Zaynah Sadiq3
1Internal Medicine Residency Program, Norton Community Hospital, Norton, Virginia, USA.
Insights
Total occlusion of one internal thoracic artery graft within six months is rare after coronary artery bypass graft surgery. Competitive flow can jeopardize arterial grafts, as seen in two patients with bilateral internal thoracic artery grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- The internal thoracic artery (ITA) is a preferred arterial conduit for coronary artery bypass graft (CABG) surgery due to its high long-term patency rates (85%-95% at 10-15 years).
- Bilateral internal thoracic artery grafting (BITA) is increasingly utilized to improve revascularization in complex coronary artery disease.
Observation:
- Competitive flow, arising from either the native coronary vessel or another arterial graft, can negatively impact graft patency.
- This phenomenon can lead to the occlusion of one of the two ITA grafts, particularly within a short period post-CABG.
Findings:
- We present two cases of patients who underwent successful CABG with BITA grafting.
- In both cases, one of the two ITA grafts experienced total occlusion within six months of surgery, a rare complication.
Implications:
- These cases highlight the potential risk of competitive flow in BITA procedures, leading to graft failure.
- Careful intraoperative assessment and postoperative monitoring are crucial to identify and manage competitive flow to optimize outcomes in patients undergoing BITA grafting.
Abstract:
The internal thoracic artery has a patency rate of 85%-95% at 10-15 years post coronary artery bypass graft surgery. Development of total occlusion of the internal thoracic artery within a short period (< 6 months) after the surgery is exceedingly rare. However, competitive flow between the native vessel and the conduit internal thoracic artery, or competitive flow between the 2 conduit internal thoracic arteries in a multiple arterial grafting procedure can jeopardize 1 of the 2 conduit internal thoracic arteries. We report the cases of 2 patients who had bilateral internal thoracic artery grafts, with total occlusion of 1 of the 2 grafts within a short period (6 months) after successful coronary artery bypass graft surgery.
