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Internal mammary vein to coronary artery anastomotic fistula
C N Aroney1, M B Davison, E G Stafford
1Department of Cardiology, Prince Charles Hospital, Chermside, Queensland, Australia.
Insights
Internal mammary artery grafts can unexpectedly form arteriovenous fistulas, leading to coronary artery disease recurrence. Surgical correction involved fistula ligation and saphenous vein grafting for symptom relief.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Interventional Cardiology
Background:
- Internal mammary artery (IMA) grafting is a common surgical procedure for coronary artery disease (CAD).
- IMA grafts are favored for their long-term patency rates in revascularization procedures.
- Symptomatic CAD requires effective and durable surgical interventions.
Observation:
- Two patients developed complications following IMA grafting for symptomatic CAD.
- Follow-up revealed occluded IMA grafts with an unusual communication between the IMA vein and the native coronary artery.
- Clinical presentation included early angina recurrence and continuous murmur detection.
Findings:
- An arteriovenous (AV) fistula formed between the internal mammary vein and the coronary artery.
- This fistula compromised graft function and led to symptom recurrence.
- The AV fistula represented an unexpected complication of IMA grafting.
Implications:
- This case series highlights a rare but significant complication of IMA grafting.
- Early detection of AV fistulas is crucial for managing recurrent symptoms after CABG.
- Re-operation with fistula ligation and alternative grafting (e.g., saphenous vein graft) can be effective.
Abstract:
Two patients are presented where internal mammary artery grafting was performed for the relief of symptomatic coronary artery disease. At follow-up the internal mammary artery was occluded and a communication between the internal mammary vein and the native coronary artery was demonstrated. These patients were characterised by the early recurrence of angina or the appearance of a continuous murmur. Both patients were treated by re-operation with ligation of the arterio-venous fistula and saphenous vein grafting.