Surgical management of coronary artery stenosis and peripheral artery occlusive disease of the lower extremity in a patient with neurofibromatosis: Report of a case

Abstract

We herein report the case of a patient demonstrating both coronary artery and peripheral artery occlusive disease with neurofibromatosis, which were successfully treated during the same session with coronary artery bypass graft surgery and a femoropopliteal bypass graft surgery procedure. The recognition of a possible association between neurofibromatosis and coronary artery and other vascular structures will further facilitate the successful surgery and clinical management of this rare clinical entity.

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

“…Tins et al (125) characterized a 6-cm CAA in an asymptomatic patient with neurofibromatosis type 1 by using CT and MR imaging. Various case reports document a single CAA in living patients with neurofibromatosis type 1 (126)(127)(128), multiple CAAs (129)(130)(131), and coronary ectasia (132). Unfortunately, sudden death is a more common manifestation of neurofibromatosis type 1 with coronary artery involvement, usually owing to coronary thrombus formation and myocardial infarction (124,127,129,(133)(134)(135)(136).…”

Myocardial infarction in a 17-year-old patient due to neurofibromatosis-associated coronary aneurysm

“…8 Talay et al treated a 67-year-old man with coronary and peripheral artery occlusive disease and neurofibromatosis with simultaneous coronary artery and peripheral artery bypass graft surgery. 9 The pathophysiology of vascular pathologies in neurofibromatosis is yet to be fully elucidated. However, some explanations have been suggested.…”

“…Vasculopathy may result from failure to suppress excessive smooth muscle migration and proliferation, impaired vascular histogenesis, impaired vascular maintenance and healing due to abnormal neurofibromin function, or invasion and weakening of the arterial wall by neurofibromatous tissue. 1,9,10 Coronary artery aneurysm is a localised dilatation in the coronary artery segment more than 1.5-fold normal size compared with adjacent normal segments. It is most commonly observed in the right coronary artery.…”

“…, 6 , 7 Fuchi et al reported coronary vasospasm reflecting abnormality of the cardiac sympathetic nerve in a case with neurofibromatosis and an organic coronary lesion, which was treated by percutaneous coronary angioplasty 8 . Talay et al treated a 67-year-old man with coronary and peripheral artery occlusive disease and neurofibromatosis with simultaneous coronary artery and peripheral artery bypass graft surgery 9 …”