Korean J Thorac Cardiovasc Surg.  1999 Oct;32(10):897-902.

Reconstruction of Injured or Inadquate Left Internal Thoracic Artery in Cornonary Artery bypass Graft

• Lee YT
• Jeon HJ
• Kim SC
• Jo JY
• Jun YB
• Lee SG
• Kim WS
• Oh SS
• Kim WH
• Ra CY
• Kim CW
• Park YK
• Mun HS

Abstract

BACKGROUND: Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. MATERIAL AND METHOD: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). RESULT: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well.
CONCLUSION
Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results.

Keyword

Coronary artery bypass graft; Internal thoracic artery; Reconstruction

MeSH Terms

Angiography
Arteries*
Coronary Vessels
Humans
Mammary Arteries*
Mortality
Standard of Care
Transplants*