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Breast infarction after internal mammary artery harvest in a patient with calciphylaxis

D J Morris1, A H Fischer, J Abboud

  • 1Carney Hospital, Dorchester, Massachusetts, USA. dmorris@bidmc.harvard.edu

The Annals of Thoracic Surgery
|December 5, 1997
PubMed

Insights

Internal mammary artery harvest for bypass surgery can cause wound complications. This case report details breast necrosis in a patient with end-stage renal disease and calciphylaxis after artery removal.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Nephrology

Background:

  • Internal mammary artery (IMA) is frequently used in coronary artery bypass grafting (CABG).
  • IMA harvest complications are typically wound-related, including sternal necrosis.
  • Patient comorbidities can influence surgical outcomes and complication risks.

Observation:

  • This case report details a patient with ESRD and a history of calciphylaxis.
  • The patient underwent internal mammary artery harvest for CABG.
  • Post-operatively, the patient developed complete ischemic necrosis of the breast.

Findings:

  • Internal mammary artery harvest can lead to severe, non-healing breast necrosis.
  • This complication is particularly concerning in patients with ESRD and calciphylaxis.
  • The vascular compromise following IMA harvest was extensive.

Implications:

  • Consider alternative arterial conduits in high-risk patients with ESRD and calciphylaxis.
  • Careful patient selection and risk stratification are crucial for preventing severe complications.
  • This case highlights the potential for devastating ischemic complications beyond typical wound issues.

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