Limb Ischemia Due to Use of Internal Thoracic Artery in Coronary Bypass (original) (raw)
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Journal of Turgut Ozal Medical Center
Peripheral vascular operations carry high risks for myocardial infarction. In cases with severe coronary artery disease and peripheric vascular disease, combined interventions might have positive effects on patient's recovery without increasing mortality or morbidity. A 67 years old male patient came to our outpatient clinic with rest pain complaint in the right extremity. The examinations showed that his right common iliac artery was occluded and there was severe stenosis on the left anterior descending artery and the right posterior descending coronary artery. We performed a coronary artery bypass surgery with cardiopulmonary bypass. In addition, we simultaneously performed an extraanatomic ascending aorta-right common femoral artery bypass with a 8 mm knitted polytetrafluoroethylene graft. At length, the patient was discharged without any problems following the recovery period.
An unusual cause of ischemia after coronary bypass grafting!!
Revista Portuguesa de Cardiologia (English Edition), 2018
Coronary subclavian steal syndrome is an uncommon cause of ischemia recurrence after coronary artery bypass grafting. Endovascular treatment of subclavian artery stenosis or occlusion is increasingly common and appears to offer a safe and effective alternative to surgical revascularization. We report a case of recurrent angina after coronary artery bypass grafting for critical subclavian artery stenosis. The anomalous origin of the vertebral artery from the aortic arch was an indication for endovascular treatment. We discuss the diagnostic difficulties and the management pitfalls of subclavian artery angioplasty in this syndrome.
Journal of Cardiothoracic Surgery
Background Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. Methods We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within...
Peripheral Vascular Disease as Predictor of Outcome after Coronary Artery Bypass Grafting
Scandinavian Journal of Surgery, 2002
Background and Aims: Understanding and objective assessment of risks is crucial in cardiac surgery. The aim of this study was to assess the influence of peripheral vascular disease (PVD) on morbidity, mortality and outcome in coronary artery bypass grafting (CABG) patients. Material and Methods: The ankle-brachial pressure index (ABPI) was used as indicator of PVD and was measured in 178 CABG patients. Two groups were established: 1. normal ABPI (0.9-1.3) (n =136) and 2. lowered ABPI (< 0.9) (n =35). The mean follow-up was 26 months. Results: The presence of PVD was 20.5 %. Patients with PVD were older (p <0.05), more often of female sex (p <0.05), had higher Higgins's risk score (p =0.001) and more often intermittent claudication (IC) (p <0.001). PVD significantly predicted atrial fibrillation (FA) (p <0.05) and relatively postoperative myocardial infarction (MI) (p =0.058). Conclusions: The presence of PVD is relatively high in CABG patients and increases with age. PVD predicts some morbidity but seems to have fairly little influence on shortterm or middle-term outcome of CABG patients. ABPI may be of only limited value in identifying patients with high operative risk in CABG.
Journal of Cardiac Surgery, 2019
Background: We carried out a propensity score-based analysis on early outcomes after coronary artery bypass grafting (CABG) in patients with and without peripheral artery disease (PAD). Materials and Methods: A total of 11 311 patients undergoing isolated CABG between 1997 and 2017 were included in the study. Patients were divided into two groups based on whether they were affected (n = 1961) or not affected (n = 9350) by PAD. Inverse probability of treatment weighting was employed to reduce confounding preoperative and operative variables. The main endpoints were death, cardiac death, stroke, and limb ischemia requiring percutaneous or surgical revascularization. Results: The excellent balance was obtained, and the groups were very similar. For death and cardiac death, there were no differences between patients with and without PAD (P = .06 and P = .179, respectively). In contrast, PAD patients showed a higher incidence of stroke (P = .04), acute kidney disease (AKD) (P = .003) and limb ischemia requiring intervention (P < .001) than patients without PAD. Conclusions: The presence of peripheral arterial disease increases the incidence of postoperative stroke, AKD and limb ischemia requiring intervention, independent of patient characteristics, concomitant risk factors, surgical approaches, and techniques. Further larger studies are necessary to confirm our findings. K E Y W O R D S coronary artery bypass, peripheral arterial disease, peripheral vascular disease 1 | INTRODUCTION Patients with coronary artery disease (CAD) are likely to have generalized arteriosclerotic lesions that also widely affect the peripheral arterial vascular system. 1 Indeed, approximately 40% of CAD patients have peripheral arterial disease (PAD), 2 and the incidence of CAD in patients undergoing peripheral vascular operations is up to 78%, 3 significantly increasing with age. 4 In addition, among CAD patients who are candidates for coronary artery bypass grafting (CABG), the prevalence of PAD ranges between 10% and 30%, 5,6 and a no negligible number of patients with extracardiac arteriopathy experience post-CABG lower limb ischemia. 7 Poorer long-term outcomes following CABG have been
[Simultaneous coronary artery bypass grafting and the ascending aorta to bifemoral bypass]
PubMed, 2011
Objective: Coronary artery disease and arteriosclerosis obliterans (ASO) frequently coexist. Concomitant revascularization procedures may be required because harvest of the internal thoracic artery (ITA) in patients with ASO carries a risk of leg ischemia. This study reports our experience with combined coronary and femoral revascularization using the ascending aorta to bifemoral bypass. Patients: Seven male patients (including 4 high aortic occlusions) underwent concomitant aorto-femoral bypass and coronary revascularization between 1990 and 2007. Mean age was 66 years old. Results: Coronary artery bypass grafting (CABG) was performed on-pump in 5 cases and off-pump in 2 cases. The number of bypass grafts were 2.4 +/- 0.9. We harvested ITA in all cases. The prosthetic tube graft was positioned behind the muscles of the abnominal wall. One hospital death was related to mediastinitis. Perfect patency of the aorta-femoral grafts was obtained in all cases. Conclusions: The ascending aorta is a good source of inflow to femoral arteries and the ascending aorta to bifemoral bypass did not require an intraperitoneal procedure. Therefore the simultaneous operation can be performed in shorter time, and it is an interesting alternative in cases with ischemic heart disease and leg ischemia.
Need for Late Lower Limb Revascularization and Major Amputation after Coronary Artery Bypass Surgery
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. The aim of the present study was to estimate the need for late lower limb revascularization and/or major amputation after coronary artery bypass grafting (CABG). Design. Retrospective study. Patients and methods. 1307 residents of Oulu who underwent CABG from 1990 to 2006 formed the basis of this community-wide study. Results. During a mean follow-up of 7.1 AE 4.5 years, 111 patients (8.5%) underwent 251 vascular procedures for lower limb ischemia and 25 major amputations. In four patients, revascularization was done for complicated wound after vein graft harvesting. Freedom rates from lower limb revascularization and/or major amputation at 5-, 10-and 15-year were 92.9%, 88.4% and 85.1%, whereas freedom rates from lower limb revascularization for critical ischemia and/or major amputation were 98.1%, 95.2% and 94.7%. Age (p ¼ 0.013, HR 1.05), extracardiac arteriopathy (p < 0.0001, HR 5.39), left ventricular ejection fraction classes (p ¼ 0.03), diabetes (p < 0.0001, HR 5.78), and estimated glomerular filtration rate <60 mg/min/m 2 (p ¼ 0.02, HR 2.22) were independent predictors of lower limb revascularization for critical leg ischemia and/or major amputation. Conclusions. Patients with extracardiac arteriopathy, diabetes and decreased glomerular filtration rate at the time of CABG are at risk for late lower limb ischemia. These patients would most benefit of a closer follow-up for prevention of peripheral vascular disease and its related complications.
Thigh ischemia complicating femoral vessel cannulation for cardiopulmonary bypass
The Annals of Thoracic Surgery, 1996
Compartment syndrome of the lower leg is an occasional complication of prolonged ischemia and reperfusion. Compartment syndrome of the thigh is a less wellrecognized complication. We present 2 patients with compartment syndrome of the ipsilateral thigh after femoral arterial and venous cannulation for cardiopulmonary bypass. Early diagnosis and urgent decompressive fasciotomy may limit the extent of local tissue damage and subsequent myonephropathic syndrome.
Journal of Cardiac Surgery, 2007
Background: This study aimed to evaluate the degree and incidence of atherosclerosis in internal thoracic (ITA) and radial arteries (RA) harvested for coronary bypass grafting. Materials and Methods: The association of major clinical events and etiological factors for atherosclerosis was investigated in 770 arterial segments obtained prospectively from 480 patients. Potential risk factors for atherosclerosis were age, gender, smoking, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, chronic renal failure, hypercholesterolemia, obesity, hypertension, and a positive family history. Results: Six types of histological lesions have been defined; grade III or more was present in the RA in 47 (16%) patients and in the ITA in 30 (7%). The mean grade was 1.6 ± 0.6 in the ITA and 2.1 ± 0.9 in the RA (p < 0.001). Conclusion: RA had a significantly greater prevalence of atherosclerosis than the same patients' ITA. There was a strong correlation between ITA atherosclerosis and age. The presence of calcification may lead surgeons to avoid an extra incision according to risk factors, although most of these are not predictive.