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Lower extremity ischemia secondary to internal thoracic-coronary artery bypass grafting
S Kitamura1, K Inoue, K Kawachi
1Department of Surgery III, Nara Medical College, Nara, Japan.
Insights
Internal thoracic artery grafts for coronary artery bypass can rarely cause limb ischemia. Simultaneous revascularization is now performed when the artery is a key collateral to the leg circulation.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Myocardial Revascularization
Background:
- The internal thoracic artery (ITA) is a preferred conduit for coronary artery bypass grafting (CABG) due to its patency rates.
- Vascular complications are rare but can be severe, including acute limb-threatening ischemia.
Observation:
- In rare cases, the ITA may serve as a critical collateral vessel supplying an obstructed aortoiliac artery system.
- This collateral function can lead to severe peripheral vascular insufficiency after CABG.
Findings:
- The use of the ITA for myocardial revascularization can precipitate limb ischemia if it is a major collateral to the lower extremity.
- This complication, though infrequent, carries devastating consequences for patients.
Implications:
- Performing simultaneous revascularization of the myocardium and the lower extremity is crucial when the ITA appears to be a major collateral to the ipsilateral aortoiliac system.
- This approach mitigates the risk of peripheral vascular insufficiency and limb loss.
Abstract:
Vascular complications associated with the use of the internal thoracic artery as a conduit for coronary artery bypass are infrequent. However, acute limb-threatening ischemia can occur after the use of the internal thoracic artery for myocardial revascularization when this vessel forms an important collateral to an obstructed aortoiliac artery system. Although this is a rare complication, the consequences are devastating. Due to the risk of peripheral vascular insufficiency, we now perform simultaneous revascularization of the myocardium and the lower extremity when an internal thoracic artery that appears to be a major collateral to the ipsilateral aortoiliac system is used.