Document Detail


A further word of caution before using the internal mammary artery for coronary revascularization in patients with severe peripheral vascular disease!
MedLine Citation:
PMID:  19937782     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 internal mammary arteries may become a major collateral route to the lower extremities. METHODS: A case series of 15 patients admitted for diagnostic coronary angiography were retrospectively identified, who were observed to have collateral flow from one or both internal mammary artery(ies) to an occluded or stenotic iliac artery. RESULTS: The mean age was 63.2 +/- 11.2 years; eight were men (53.3%). Coronary angiography was done as a perioperative evaluation for peripheral vascular surgery in three patients (20%) and was done because of cardiac symptoms or a positive thallium scan in 12 (80%). The finding that the mammary artery collateralized the iliac artery led to major treatment changes in all patients, seven (46.6%) who required CABG. In five patients (33%), use of one or both internal mammary artery(ies) for coronary grafts was avoided. CABG was deferred in one patient, whereas in another, percutaneous intervention in both iliac arteries preceded CABG using both mammary arteries. There was no incidence of postoperative acute lower extremity ischemia. CONCLUSIONS: Selective angiographic visualization of the internal mammary artery is an essential part of the preoperative evaluation in patients with severe peripheral vascular disease undergoing CABG.
Authors:
Itsik Ben-Dor; Ron Waksman; Lowell F Satler; Nelson Bernardo; Rebecca Torguson; Yanlin Li; Manuel A Gonzalez; Gabriel Maluenda; Gaby Weissman; Nicholas N Hanna; Alan Monath; Robert Gallino; Joseph Lindsay; Kenneth M Kent; Augusto D Pichard
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  75     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-04-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  195-201     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arterial Occlusive Diseases / complications*,  physiopathology,  radiography
Collateral Circulation*
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease / complications,  physiopathology,  radiography,  surgery*
Female
Humans
Iliac Artery / physiopathology*,  radiography
Internal Mammary-Coronary Artery Anastomosis / adverse effects*
Lower Extremity / blood supply*
Male
Middle Aged
Patient Selection
Regional Blood Flow
Retrospective Studies
Risk Assessment
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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