Doppler features of occlusion of the internal thoracic artery due to preoperative branch embolization

A 61-year-old male was referred to the surgical ward by cardiologists becau se of a diagnosis of unstable angina with 3-vessel disease. On preoperative left internal thoracic arteriography, a large first intercostal branch was found at the proximal portion. Selective arterial embolization of the bran ch of the left internal thoracic artery (LITA) was carried out preoperative ly. At 2 days after embolization, the Doppler peak flow velocity and diamet er of the LITA were increased and enlarged compared with before the procedu re. However, a large reverse wave following after the first systolic peak f low of the LITA was newly detected after embolization. Upon operation, the LITA was found to be occluded at the 2nd intercostal space due to thrombus formation. Therefore, the right internal thoracic artery was anastomosed to the left anterior descending artery and coronary reversed saphenous vein g rafts were joined to segment 4PD of the right coronary artery. The postoper ative course was uneventful. There has been no previous report of an LITA b ranch being embolized preoperatively. It was possible to diagnose the graft problem by detecting the altered Doppler wave form of the LITA.