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An Elegant Approach for Complete Revascularization of the Circumflex Territory
Ziyad Gunga1, Mario Verdugo-Merchese1, Matthias Kirsch1
1Department of Cardiovascular Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland.
Insights
This case study demonstrates a novel surgical technique for coronary artery bypass grafting in the circumflex territory. Using the right internal thoracic artery for direct circumflex trunk grafting offers a feasible alternative to complex distal procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Revascularization of the circumflex artery is challenging due to its anatomical location.
- Often requires complex distal bypass grafting.
- This limits treatment options for some patients.
Abstract:
Background and Clinical Significance: Revascularization of the circumflex territory remains technically challenging because of its anatomical position and the frequent need for distal branch grafting. Case presentation: We report the case of a 76-year-old man in whom the proximal circumflex trunk was used as the target for an in situ right internal thoracic artery routed through the transverse sinus during combined coronary and ascending aortic surgery. This approach allowed antegrade perfusion of the circumflex territory while avoiding multiple distal anastomoses. In this selected anatomical setting, the technique proved feasible and was associated with excellent intraoperative flow and 1-year radiological patency. Conclusions: Direct grafting of the circumflex trunk is not a new concept, but this case revisits it using a contemporary total arterial revascularization strategy. This approach may represent a useful adjunctive option in carefully selected patients with favorable circumflex anatomy.