The impact of chronic renal failure on atherosclerosis of the internal thoracic arteries

Background. Little is known about the impact of renal failure on atheroscle rotic changes in the internal thoracic artery (ITA). Methods. A total of 20 consecutive patients on chronic dialysis who underwe nt coronary artery bypass grafting (CABG) during April 1998 through Septemb er 1999 were investigated. The 20 control patients were selected from the s ame interval to rigorously match risk factors. Atherosclerosis of the ITA c ollected from each patient was analyzed using the subjective evaluation pro posed by Kay and colleagues. Results. There were no cases of greater than 25% atherosclerotic luminal na rrowing among a total of 35 ITA specimens from dialysis patients. The degre e of atherosclerosis was not significantly different from that of the speci mens from matched patients (p = 0.18). No calcification was found in ITA gr afts either microscopically or macroscopically. The number of elastic lamel lae, an index of the elasticity of the ITA graft, was not significantly dif ferent from those obtained from the matched patients. Analysis of preoperat ive coronary angiography revealed that coronary calcification was significa ntly more frequent in dialysis patients (15 patients, 75%) than in matched patients (p < 0.05). By analysis of postoperative angiography in dialysis p atients, no evidence of atherosclerotic changes was found in 28 opacified I TAs. In addition, despite the presence of calcification in the native coron ary, no calcification was evident along the entire length of the ITAs. Conclusions. This study revealed the minimal impact of chronic renal failur e on atherosclerotic changes in the ITA. The results of this study support the continued use of ITA grafting in dialysis patients. (Ann Thorac Surg 20 01;71:148-51) (C) 2001 by The Society of Thoracic Surgeons.