OBJECTIVES: To characterize the clinical and angiographic characteristics of patients with collateralization from the internal mammary artery to the iliac artery. BACKGROUND: The use of the internal mammary arteries for coronary revascularization has become the standard of care in coronary artery bypass grafting (CABG). However, in patients with aortoiliac disease, ...

The diagnosis and management of ischemic symptoms in patients after coronary artery bypass surgery can be challenging. It has been hypothesized that persistent branches of the internal mammary artery can divert flow from the left anterior descending artery and cause symptoms. We present a case in which successful coil embolization ...

Totally endoscopic coronary artery bypass grafting (CABG) has become a feasible option using robotic technology and remote access perfusion techniques. The aim of this study was to determine the progression of the procedure's performance in the currently largest single-center series of arrested-heart totally endoscopic CABG. From 2001 to 2007, arrested-heart ...

OBJECTIVES: We report our comparative experience of on-pump and off-pump full arterial coronary artery bypass grafting (CABG) using both internal mammary arteries (IMAs) anastomosed as a Y-graft. METHODS: A single-center clinical study was conducted prospectively between January 2003 and May 2008. It compared the short- and mid-term clinical outcomes of ...

The internal mammary artery perforator flap has been used in head and neck reconstruction. Although anatomical and perfusion studies with ink have been performed previously, the authors now use three- and four-dimensional computed tomographic angiography to precisely visualize vascular anatomy of individual perforators (perforasomes) and the axiality of perfusion. Eleven ...

We describe complete emergency arterial coronary artery bypass grafting performed on the beating heart of a 73-year-old man with situs inversus totalis and triple-vessel disease. The right internal mammary artery was anastomosed to the left anterior descending artery in situ. The first and second obtuse marginal branches of the circumflex ...

PURPOSE OF REVIEW: Multiple cohort studies have shown that long-term outcomes after coronary surgery can be markedly improved when bilateral internal thoracic arteries (BITA) are used for revascularization. Applying this strategy is challenging, however, as a large proportion of patients suffer from comorbidities such as diabetes, and sternal devascularization with ...

Ischemic spinal cord injury remains a major complication of both open and endovascular repairs of extensive lesions of the thoracic or thoracoabdominal aorta. Patients undergoing endovascular treatment cannot benefit from direct revascularization of the Adamkiewicz artery (AA). Primary revascularization of the intercostal artery (ICA) giving rise to the AA using ...

Spontaneous coronary artery dissection (SCAD) is a relatively rare but important cause of acute coronary syndrome. The diagnosis is often made at autopsy. Risk factors include the peripartum period, oral contraceptive use, and atherosclerotic disease. SCAD must be considered every time a healthy young patient presents with an onset of ...

The use of the internal thoracic artery for coronary artery bypass has improved the results of such surgery. However, bypass using only the internal thoracic arteries sometimes requires a T-graft. This purely internal thoracic artery T-graft technique has progressively become part of our surgical protocol for coronary artery bypass surgery. ...

An uncommon case of traumatic arteriovenous fistula of the left internal mammary artery following penetrating chest trauma is presented. The patient developed a left parasternal machinery murmur six days after thoracotomy to repair a pericardial tamponade after a penetrating left parasternal stab wound. Selective digital subtraction angiography revealed pseudoaneurysm formation ...

There is overwhelming evidence that internal mammary artery grafts improve survival and clinical outcomes after coronary artery bypass graft surgery. It has therefore become standard practice to use the left internal mammary artery as the graft of first choice. Given the overwhelming evidence for the superiority of internal mammary artery ...

The deep inferior epigastric perforator (DIEP) flap has become an increasingly popular option for postmastectomy reconstruction. The purpose of this study was to evaluate the retrograde limb of the internal mammary vein as a recipient vein in DIEP breast reconstruction. Fifteen consecutive DIEP flaps in 13 patients were transferred with ...

We have performed 12 cases of robotically assisted coronary artery bypass grafting (CABG) to accomplish less invasive revascularization. In this report, we describe a new method of robotically assisted internal thoracic artery (ITA) harvesting via subxiphoid approach, using the da Vinci surgical system. A 22-year-old man with three-vessel coronary artery ...

Graft aneurysms following aortocoronary surgery are a rare occurrence in clinical practice. Reported cases have mostly involved saphenous vein grafts. Here we report the rare finding of a tandem aneurysm of an internal mammary artery graft which was incidentally detected 17 years following bypass surgery. (Neth Heart J 2009;17:300-2.).

A 55-year-old male without previous medical history developed chest pain. Coronary catheterization showed left main coronary dissection. Coronary artery bypass grafting was performed using bilateral internal mammary arteries, which were very fragile. The specimens of the internal mammary arteries sent for pathology showed cystic medial necrosis.

Hybrid revascularization provides minimally invasive options for high-risk patients with multivessel coronary artery disease. We used a hybrid approach in two patients. The surgical revascularization with the left internal mammary artery (LIMA) on the left descending coronary artery was performed through an inferior j-shaped mini-sternotomy keeping the patients awake with ...

We determined whether ultrasonographic left internal mammary artery (LIMA) findings correspond with 64 multislice computed tomography (MSCT) in patients 12 years after coronary artery bypass grafting. We included 34 patients (63.2+/-9.2 years), 16 with conventional single LIMA (group I) and 18 arterial T-grafts (group II), in a cross-sectional study. Patients ...

Graft preference is a key point for long-term patency in coronary artery bypass grafting. We present a patient with multivessel coronary artery disease who underwent coronary artery bypass grafting 18 years ago. Revascularization of the left coronary system was performed by using a combined internal mammary artery (IMA) graft, which ...

Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based ...

BACKGROUND: Selective skeletonization of the internal mammary artery (IMA) without adjacent vasculo-muscular structures reduces trauma to the chest wall, results in elongated grafts, makes ideal graft positioning possible, and eliminates the need to implant a dissected or hypoplastic graft with direct visual control of the vessel. We compared two techniques ...

Total arterial revascularization in patients with three-vessel disease cannot usually be achieved by bilateral internal thoracic artery grafts alone due to limited length. In this report we describe a technique by which the right internal thoracic artery can be elongated with radial artery for sequential grafting in redo total arterial ...

Recurrence of symptoms after CABG surgery might be caused by formation of fistulous connections between LIMA and pulmonary vasculature. Percutenous route via coil embolization of these connections has been chosen for the initial treatment modality in majority of cases. However, percutenous coronary intervention of native vessel can be considered as ...

To assess, by scintillography, the effect of using bilateral internal thoracic arteries (BITAs) - prepared by two different techniques - on the sternal perfusion. 35 patients undergone coronary artery bypass grafting (CABG) were divided into two groups: Group A (18) had both ITA's dissected using skeletonization technique and group B ...

BACKGROUND: Arterial conduits having long-term patency rates have been increasingly used for bypass of coronary arteries although some risk factors for their occlusion such as recipient vessel size, older age, and hyperlipidaemia have been described. Obesity, on the other hand, has been well established as a coronary risk factor. However, ...

We describe a case of stenting to a distal left anterior descending artery stenosis via the native vessel aided by contrast injection via a left internal mammary artery graft. This dual visualization technique allows good distal vessel opacification whilst minimising instrumentation of the internal mammary artery and its associated risks.

Adhesions or unattended injury are known but are seldom reasons to prevent withdrawing the use of the left internal thoracic artery during coronary artery bypass grafting. The patient in this case report was a 68-year-old man, who had undergone repair for aortic coarctation 34 years prior to coronary artery bypass ...

OBJECTIVE: We aimed to preserve sternal vascularity better by harvesting only midsegment of the right internal thoracic artery (RITA) than using conventional bilateral internal thoracic artery (BITA) harvesting method, and we evaluated the sternal vascularity with single photon emission computed tomography (SPECT). METHODS: In this prospective clinical randomized investigation, 135 ...

OBJECTIVES: This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. BACKGROUND: The value of a routine completion angiogram after CABG and 1-stop ...

We present the case of a 12-year-old girl with familial hypercholesterolemia and coronary artery disease. She underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ ...

Minimally invasive direct coronary artery bypass (MIDCAB) is performed through a left anterior mini-thoracotomy without the use of a cardiopulmonary bypass and offers greater potential for more rapid recovery, reduced pain and a decreased need for blood transfusion than conventional coronary artery bypass grafting. Few major complications of the MIDCAB ...

It is widely accepted that in coronary artery surgery, the left internal mammary artery (LIMA) can be used as the single source of blood inflow to multiple coronary grafts as in the T-graft technique. We, herein, present clinical evidence suggesting that in ischemic hypertrophied hearts, single arterial inflow from the ...

We report for the first time a case of a 54 years old man with a fatal motorcycle accident due to an external bleeding compression of left internal mammary artery graft to the left anterior descending artery. The possibility of cardiac failure in trauma caused by external compression or traumatic ...

The long-term benefits of a left internal mammary artery bypass graft to the left anterior descending artery (LAD) have been well described. As the patient population with multivessel coronary artery disease has grown older with greater comorbidities, less invasive approaches to revascularization have been explored. The use of drug-eluting stents ...

The gold-standard bypass graft to the left anterior descending coronary artery is the left internal thoracic artery harvested with its pedicle. At times, however, the length of the internal thoracic artery is insufficient for distal anastomosis. Different methods of lengthening the internal thoracic artery or of reducing the distance to ...

We have previously reported the initial clinical feasibility with our small diameter tissue engineered blood vessel (TEBV). Here we present in vitro results of the mechanical properties of the TEBVs of the first 25 patients enrolled in an arterio-venous (A-V) shunt safety trial, and compare these properties with those of ...

In this report, we describe a continuous murmur heard in a young woman at the beginning of her lactation period, which illustrates a typical example of 'Mammary Souffle', described one century ago. Colour Doppler and pulsed-wave mode echocardiogram allowed to precise, for the first time, the arterial nature of increased ...

Atherosclerosis of the internal mammary artery is a rare disease. We describe a case in which a 41-year-old man underwent coronary artery bypass surgery 23 years after repair of aortic coarctation. The diseased mammary artery was used to graft the left anterior descending coronary artery after intraoperative confirmation of good ...

The left internal mammary artery (IMA) is the preferred native graft for left anterior descending revascularisation owing to its favourable long-term patency and resistance to atherosclerosis. Incomplete ligation of the IMA side branches may cause recurrent angina due to flow diversion. Reoperation for ligating this unligated side branches may be ...

BACKGROUND: The main aim of the present study was to compare the occurrence of inflammatory cell infiltrates in the aorta, a vessel with a high occurrence of atherosclerosis, with that in the saphenous vein (SV) and internal mammary artery (IMA), which are protected from atherosclerosis. METHODS AND RESULTS: Samples from ...

Physiologic mastectomy can be used as a salvage procedure in cases of chronic suppurative mastitis, gangrenous mastitis, or chronic, severe mastitis associated with organisms liberating endotoxin or exotoxin. The surgical technique involves ligation of the major arterial blood supply (external pudendal artery) to the corresponding half of the mammary gland, ...

A 62-year-old man underwent radiotherapy to the left upper chest for treatment of Pancoast syndrome on a background of previous coronary artery bypass grafting 12 years earlier. Within 1 year, he developed significant stenoses of both the left internal mammary artery (LIMA) graft and ostial left vertebral artery, presumably related ...

We present a case of hybrid coronary revascularization complicated by delayed bleeding from an anastomotic site. Anastomosis of the left internal mammary artery to the left anterior descending coronary artery was successfully performed via a lateral anterior small thoracotomy. Scheduled subsequent percutaneous coronary intervention of residual stenoses was successfully performed ...

Rats are used widely in ischemia-reperfusion and other heart experiments, but current protocols for thoracotomy have serious shortcomings. Median sternotomy causes bleeding from sternum itself and the internal thoracic arteries, whereas left thoracotomy requires exteriorization of the heart and its reintroduction after completion of the procedure and often is complicated ...

Two patients with congenital atresia of the left coronary artery ostium underwent myocardial revascularization at the age of three years and three months, respectively. The patients were admitted to the hospital with a clinical history of sudden chest pain or short apnea not necessitating resuscitation. Non-invasive examinations and hemodynamic studies ...

Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues ...

PURPOSE: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. MATERIALS AND METHODS: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal ...

Dextrocardia is a rare condition that may be congenital (situs inversus) or acquired (pseudodextrocardia). Since individuals with this ailment have normal cardiac physiology and function, they may live normal lives. Similar to the general population, however, they might be susceptible to ischemic heart disease and present to a cardiothoracic surgical ...

PURPOSE: Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery ...

Coronary steal due to an unligated side branch of the internal mammary artery graft is a rare but important pathology causing ischaemia. We describe the case of a patient with significant ischaemia having an unligated side branch of the left internal mammary artery after coronary artery bypass surgery and who ...