Atherosclerosis and the internal mammary arteries

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Radiology

Background:

• Coronary artery disease (CAD) affects millions globally.
• Internal mammary arteries (IMAs) are crucial for coronary artery bypass grafting (CABG).
• Peripheral vascular disease (PVD) prevalence in CAD patients warrants investigation of associated arterial conditions.

Purpose of the Study:

• To determine the incidence and extent of atherosclerosis in internal mammary arteries (IMAs) in patients with coronary artery disease (CAD).
• To assess the impact of coexisting peripheral vascular disease (PVD) on IMA atherosclerosis.
• To evaluate the implications of IMA and related artery atherosclerosis for coronary bypass surgery.

Main Methods:

• Bilateral internal mammary arteriography was performed on 150 patients with CAD.
• Patients were assessed for coexisting peripheral vascular disease (PVD).
• Atherosclerotic lesions in IMAs, brachiocephalic, and subclavian arteries were analyzed.

Main Results:

• Significant atherosclerosis was found in only 2% of IMAs, with one case in a patient with PVD.
• Atherosclerosis in IMAs was located proximally or distally.
• Six patients (4% of total) with PVD had significant brachiocephalic artery atherosclerosis.
• Proximal subclavian artery atherosclerosis, a contraindication for IMA grafting, was noted.

Conclusions:

• Atherosclerotic involvement of the IMA is uncommon and typically does not preclude its use in CABG.
• Atherosclerosis of the subclavian arteries is more prevalent and can be a contraindication for IMA grafting.
• Routine arteriography of IMAs is valuable for assessing graft suitability in select CAD patients.