The Unligated Left Internal Mammary Artery Side Branch as the Cause of Angina after Coronary Artery Bypass Grafting

2012 ◽  
Vol 15 (4) ◽  
pp. 240 ◽  
Author(s):  
Jan Z. Peruga ◽  
Agata Bielecka-Dabrowa ◽  
Jarosław D. Kasprzak
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Side Branch ◽  
Embolization Coil ◽  
Internal Mammary ◽  
Coronary Steal

The left internal mammary artery (LIMA) is a widely used conduit during coronary artery bypass graft (CABG) surgery because of its excellent long-term patency. Although large LIMA side branches are typically ligated during the surgery, the occurrence of a coronary steal phenomenon related to these side branches following surgery remains controversial. Advocates for occlusion of LIMA side branches in the setting of left anterior descending artery (LAD) ischemia indicate that anginal symptoms often improve and that objective measures of LAD ischemia frequently resolve. We present a patient with ischemia in the LAD distribution secondary to coronary steal from a large LIMA side branch that was successfully treated using the Embolization Coil-IMWCE-3-PDA5 (Cook Medical, Bjaeverskov, Denmark).

scholarly journals Incidental Finding and Endovascular Repair of a Left Internal Mammary Artery Aneurysm following a Multivessel Coronary Artery Bypass Graft

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Osayi Lawani ◽  
Jiries Ganim ◽  
Rick Ganim
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Endovascular Repair ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Artery Bypass Graft ◽  
Internal Mammary

True aneurysms discovered within the internal mammary artery are extremely rare and typically have an asymptomatic occurrence. Their presentation and management have also been variable due to their low incidence, decreased detection, or lack of documentation. They have a high risk for morbidity or mortality as they can possibly rupture with increasing size and thus become life-threatening. Coronary CT angiography is the most definitive test for confirming and finding complications related to the aneurysm. With an increase in the aging population and advancement in the techniques used in coronary artery bypass grafting, it is likely that the rate of recorded occurrence of aneurysms and pseudoaneurysms will increase. Endovascular repair is currently the most favored treatment modality. In this report, we describe a case of a 74-year-old male who was incidentally found to have a left internal mammary artery aneurysm following complaints of chest pain related to another nearly occluded grafted vessel. To the best of our knowledge, and following an extensive literature review, this is likely the first documented case of a true aneurysm found within a left internal mammary artery bypass graft. The patient recovered well following placement of a covered stent; however, upon follow-up one year later, he was found to have stenosis of the same vessel, which was subsequently treated without further complication.

scholarly journals Near-fatal kinking of mammary graft due to emphysematous lung disease

2018 ◽  
Vol 6 ◽  
pp. 2050313X1876722
Author(s):  
John T Denny ◽  
Sagar Mungekar ◽  
Benjamin R Landgraf ◽  
Valerie A McRae ◽  
Sajjad Ibrar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Chronic Obstructive ◽  
Artery Bypass Graft ◽  
Internal Mammary

Left internal mammary artery grafting is commonly used in elective coronary artery bypass graft surgery. We report a near-fatal case with graft kinking upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. After the sternum was closed, the patient suffered a severe hemodynamic deterioration. Surgical examination revealed kinking of his left internal mammary artery upon sternal closure due to distended, emphysematous lungs impinging on the mammary graft. Using an off-bypass technique, the kink in the mammary graft to the left anterior descending artery was removed by moving the origin of the left internal mammary artery to a hooded graft of a saphenous vein graft instead. In this position, the graft no longer was impinged upon by the distended emphysematous lungs. Subsequently, the patient’s sternum was closed without hemodynamic impingement. Although chronic obstructive pulmonary disease is well described to increase complications in coronary artery bypass graft surgery, it has not been previously associated with the kinking of a left internal mammary artery. This report highlights another contribution that chronic obstructive pulmonary disease can make to increased morbidity following coronary artery bypass graft surgery and alerts readers to watch for this complication in susceptible patients.

Internal mammary artery versus autogenous vein for coronary artery bypass graft

1974 ◽  
Vol 33 (1) ◽  
pp. 167
Author(s):  
Stephen J. Rossiter ◽  
William R. Brody ◽  
Jon C. Kosek ◽  
Martin J. Lipton ◽  
William W. Angell
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Internal Mammary ◽  
Autogenous Vein

scholarly journals Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Jonathan D. Gardner ◽  
William R. Maddox ◽  
Joe B. Calkins
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Coronary Vein ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients ◽  
Internal Mammary

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

scholarly journals Refractory Angina Secondary to Large Unligated Side Branch of Internal Mammary Artery

2019 ◽  
Vol 14 ◽  
Author(s):  
Zachary Oman ◽  
Lucas Gu ◽  
Nauman Khalid ◽  
Rahil Rafeedheen ◽  
Hassan Alkhawam ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Medication Management ◽  
Side Branch ◽  
Current Data ◽  
Refractory Angina ◽  
Common Diagnosis ◽  
Internal Mammary

Coronary artery disease (CAD) has become a common diagnosis. Managing the symptoms of CAD continues to be an ongoing dilemma requiring optimal medication management or potential revascularization with either percutaneous coronary interventions or coronary artery bypass grafting (CABG). We present a case of debilitating refractory angina in a patient with severe CAD after optimal medical therapy and CABG secondary to coronary steal phenomenon via the left internal mammary artery conduit supplying a large unligated side branch to the internal chest wall. While current data are inconclusive on this phenomenon, our patient had complete resolution of angina following coil embolization of unligated side branch of the internal mammary artery.   

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