scholarly journals Occluded mammary graft post-coronary bypass surgery: do we need to look for the second one? A case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Sergey Yalonetsky ◽  
Ariel Roguin ◽  
Gil Gross ◽  
Rafael Beyar
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Bypass ◽  
Arterial Graft ◽  
Anatomical Variant ◽  
Anatomic Variant ◽  
Retrograde Filling ◽  
Internal Mammary

Abstract Background Anatomic variations of the left internal mammary artery (LIMA) can influence coronary artery bypass surgical technique as well as posing definite difficulties in the interpretation of angiographic findings. We present an unusual anatomic variant of two LIMAs originating from the left subclavian artery discovered post-coronary artery bypass grafting surgery. Case summary A 60-year-old man post-LIMA grafting of the left anterior descending (LAD) coronary artery underwent diagnostic cardiac catheterization. Selective angiography revealed occluded LIMA; therefore, it was decided to proceed with percutaneous coronary intervention (PCI) to the occluded native LAD. Once antegrade flow in the LAD was restored, retrograde filling of a vessel corresponding to the previously grafted LIMA was also detected. Additional contrast injection in the left subclavian artery (LSCA) showed a second patent LIMA originating from the distal segment of the LSCA. Discussion This patient has an unusual anatomic variant of two LIMAs originating from the LCSA. The proximal rudimentary LIMA was misinterpreted as an occluded arterial graft while the second, well-developed LIMA connected to the LAD had an unusually distal origin and had therefore been overlooked. This anatomical variant should be kept in mind when the internal mammary graft seems to be occluded.

Survival benefit from a second arterial conduit to the circumflex circulation persists in elderly after coronary artery bypass surgery

2021 ◽  
pp. 021849232199707
Author(s):  
Suvitesh Luthra ◽  
Miguel M Leiva-Juárez ◽  
Pietro G Malvindi ◽  
John S Billing ◽  
Sunil K Ohri
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Survival Benefit ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Arterial Graft ◽  
Arterial Conduit ◽  
Internal Mammary

Background This retrospective propensity matched study investigated the impact of age on the survival benefit from a second arterial conduit to the left-sided circulation. Methods Data for isolated coronary artery bypass surgery were collected from October 2004 to March 2014. All patients with an internal mammary artery graft to left anterior descending artery and additional arterial or venous graft to the circumflex circulation were included. Propensity matching was used to balance co-variates and generate odds of death for each observation. Odds ratios (venous vs. arterial) were charted against age. Results The in-hospital mortality rate was 1.12% (arterial) vs. 1.24% (venous) (p = 0.77). The overall 10-year survival was 74.6% (venous) vs. 82.6% (arterial) (p = 0.001). A total of 1226 patients were successfully matched to the venous or arterial (second conduit to circumflex territory after left internal mammary artery to left anterior descending artery) cohorts. Odds ratio for death (venous to arterial) showed a linear decremental overall survival benefit for the second arterial graft to circumflex circulation with increasing age. Conclusions The survival benefit of a second arterial graft persists through all age groups with a gradual decline with increasing age over the decades. Elderly patients should not be denied a second arterial graft to the circumflex circulation based on age criterion alone.

Left Subclavian Artery Revascularization in Preparation for Coronary Artery Bypass Grafting

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 191-194
Author(s):  
Saum A. Rahimi ◽  
Noor Shah ◽  
Volodymyr Labinskyy ◽  
Leonard Y. Lee
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Subclavian Steal Syndrome ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity.

scholarly journals Two-stage repair of the intrathoracic portion of a left subclavian artery aneurysm after previous coronary artery bypass surgery

2021 ◽  
Vol 2 (1) ◽  
pp. 33-38
Author(s):  
Petar Zlatanović ◽  
Marko Dragaš ◽  
Vladimir Cvetić ◽  
Oliver Radmili ◽  
Aleksandra Vujčić ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Arch ◽  
Coronary Artery Bypass ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Two Stage ◽  
Subclavian Artery Aneurysm

Introduction: We present a case of a 70-year-old patient who underwent successful two-stage repair of an intrathoracic left subclavian artery aneurysm (SAA) and who had previously undergone CABG. Case presentation: The patient had previously undergone three-vessel coronary artery bypass graft (CABG) repair with the use of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was performed as a backup option in case of potential intra-operative LIMA-LAD bypass occlusion. Owing to the impossibility of hybrid repair due to a short proximal landing zone and aortic arch anomaly (bovine type), the vascular surgery review board decided to perform two-stage open surgery. Firstly, the patient underwent a left carotid-subclavian (C-S) bypass with the Dacron graft, with the application of the standard supraclavicular approach. After a few days, the second procedure, through the left posterolateral thoracotomy was performed. The left subclavian artery (SA) was ligated distally to the SAA but proximally to the origin of the LIMA. The distal aortic arch at the site of the left SAA was clamped partially and the aneurysm was excised. The defect of the aortic arch was sutured and reinforced with a felt patch. Postoperatively, the patient had a good recovery, without any signs of myocardial injury or any surgery-related issues. Conclusion: Careful planning and two-stage open surgical treatment of the left SAA, first with a left carotid-subclavian bypass, followed by aneurysm exclusion and suture of the outer aortic arch curvature may be a treatment option for patients not amenable to hybrid treatment.

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