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[Coronary artery bypass grafting using arterial grafts in a patient with rheumatoid arthritis requiring steroid
1Department of Surgery, Yashima General Hospital, Takamatsu, Japan.
Insights
This study shows arterial grafts are effective for coronary artery bypass grafting (CABG) in patients with rheumatoid arthritis (RA) on steroid therapy. Both internal thoracic artery and epigastric artery grafts remained patent post-surgery.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Vascular Biology
Background:
- Rheumatoid arthritis (RA) patients on long-term steroid therapy present unique challenges for cardiovascular procedures.
- Stable angina post-myocardial infarction necessitates surgical intervention like coronary artery bypass grafting (CABG).
Observation:
- A 58-year-old male with RA on 9 years of prednisolone treatment underwent CABG for severe left anterior descending (LAD) stenosis.
- The surgical technique involved end-to-side anastomosis of the inferior epigastric artery (IEA) to the left internal thoracic artery (LITA).
- The LITA was grafted to LAD (segment 7) and the IEA to the first diagonal branch (segment 9).
Findings:
- The patient experienced an uneventful postoperative recovery with successful bypass.
- Postoperative angiography confirmed excellent patency of both the LITA and IEA arterial grafts.
- Pathological examination of graft stumps revealed mild atherosclerotic changes, suggesting good graft durability.
Implications:
- Arterial grafts, including the IEA, are a viable and effective option for CABG in RA patients receiving steroid therapy.
- This approach may offer a durable solution for managing coronary artery disease in this specific patient population.
- Further research into long-term outcomes of arterial grafting in steroid-treated RA patients is warranted.
Abstract:
We report a 58-year-old man with rheumatoid arthritis (RA) who underwent successful coronary artery bypass grafting (CABG) for stable angina after myocardial infarction. He had been receiving prednisolone for 9 years. Selective coronary angiography revealed 99% stenosis in the left anterior descending branch (LAD; seg. 6). Before going on cardiopulmonary bypass, the inferior epigastric artery (IEA) was anastomosed to the left internal thoracic artery (LITA) in end-to-side fashion. The LITA was anastomosed to LAD (seg. 7) and the IEA was anastomosed to the first diagonal branch (seg. 9). The postoperative course was uneventful and postoperative angiography showed both grafts were well patent. He is now doing well with no angina attack. The stumps of the LITA and IEA were examined pathologically with the atherosclerotic changes of both grafts relatively mild. We consider the arterial grafts are useful for CABG even in the patient with RA requiring steroid therapy.