EXTRATHORACIC ARTERIOSCLEROTIC VASCULAR CHANGES PRECLUDE THE USE OF THE INTERNAL THORACIC ARTERY FOR CORONARY-ARTERY BYPASS-GRAFTING

During a two-years period we have treated 6 patients where use of the internal thoracic artery for coronary artery grafting was precluded be cause of extrathoracic arteriosclerotic vascular lesions. In four pati ents with severe aorto-iliac occlusive disease preoperative digital an giography demonstrated collateralisation of the lower extremity by eit her the left, right, or both internal thoracic arteries (ITA). In thes e cases use of the ITA was excluded in order to preserve the collatera l supply and coronary bypass grafting was performed using only sapheno us vein. In two patients with proximal occlusion of the left subclavia n artery the right ITA was used as in-situ bypass to graft the left an terior descending artery. All patients survived the operation without development of a perioperative myocardial infarction, neurological def icit, or peripheral ischemia. Although they rarely do, extrathoracic v ascular disorders can exclude the use of the ITA far grafting. Especia lly in the case of aorto-iliac occlusive disease or proximal arteriosc lerotic subclavian lesions angiographic evaluation is mandatory to pre vent the development of life-threatening peripheral ischemia by harves ting an ITA and to avoid the use of an inadequate ITA graft with in-fl ow occlusion.