Acute transection of the left internal mammary artery remote from the anastomosis following coronary artery bypass surgery

Abstract

We report a case of spontaneous transection of the left internal mammary artery 4h after a patient underwent coronary artery bypass surgery. This complication has been reported in two patients following minimal access coronary artery bypass grafting, but to our knowledge, this is the first case of transection of the left internal mammary artery, following conventional myocardial revascularization via median sternotomy. Possible mechanisms leading to this rare, but potentially life-threatening complication are also discussed.

Long-term graft patency after coronary artery bypass grafting. Effects of morphological and pathophysiological factors

“…Compared with graft type, graft length-related patency was not analyzed by extensive studies. According to small series ( 18 ) and case presentations ( 19 ), a short, tensed graft is predisposed to spasm in the case of arteries and to flattening in the case of veins with hypoperfusion of the grafted territory compared with a long graft with excessive length that is predisposed to transection and kinking. Graft length could prove insufficient secondary to imprecise estimation of the cardiac volume or of the graft itself, peripheral localization of the target vessel, anatomical features of the graft (high ITA bifurcation), harvesting or manipulation errors (destruction of a graft segment), and pulmonary hyperinflation (emphysema).…”

Coronary artery surgery in a patient with grossly emphysematous lung

“…1 Unfortunately, an emphysematous lung occupying the whole dome of the left pleural cavity and expanding well over the midline may occasionally produce formidable traction on the pedicled LITA graft, thus compromising blood flow or even causing avulsion of the conduit. 2 Using the distal in-situ inverted LITA (LITA transected near its origin, thus supplied by retrograde flow from superior epigastric and musculophrenic arteries) as a conduit to bypass the LAD, we were able to completely avoid all complications to which the classically routed in-situ LITA conduit would be exposed in a patient with a grossly emphysematous lung.…”

Successful percutaneous treatment of a catastrophic left internal mammary artery graft avulsion occurring 4 weeks post-coronary artery bypass grafting surgery: a case report

“…In conventional CABG setting, a complete transection of the LIMA to LAD graft was first reported by Morritt et al . 6 in 2004 in a patient who deteriorated after 3 h post-operation at the time of weaning from ventilation. Emergency re-sternotomy showed complete transection of the LIMA graft 2 cm proximal to the anastomosis at the origin of a side branch which had been ligaclipped.…”

“…As mentioned above, the reported time interval between the conventional CABG operation and the graft avulsion has been very short; 1.5 h 7 and 3 h post-surgery. 6 In MIDCAB setting however the time interval has been variable; as short as 6 h post-operation following closed-chest CPR, 3 13 days post-operation following vigorous stretching exercise, 2 18 days post-operation, 5 and up to 3 months post-operation. 4…”