Abstract
During a two-years period we have treated 6 patients where use of the internal thoracic
artery for coronary artery grafting was precluded because of extrathoracic arteriosclerotic
vascular lesions. In four patients with severe aorto-iliac occlusive disease preoperative
digital angiography demonstrated collateralisation of the lower extremity by eitherthe
left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA
was excluded in orderto preserve the collateral supply and coronary bypass grafting
was performed using only saphenous vein. In two patients with proximal occlusion of
the left subclavian artery the right ITA was used as in-situ bypass to graft the left
anterior descending artery. All patients survived the Operation without development
of a perioperative myocardial infarction, neurological deficit, or peripheral ischemia.
Although they rarely do, extrathoracic vascular disorders can exclude the use of the
ITA for grafting. Especially in the case of aorto-iliac occlusive disease or proximal
arteriosclerotic subclavian lesions angiographic evaluation is mandatory to prevent
the development of life-threatening peripheral ischemia by harvesting an ITA and to
avoid the use of an inadequate ITA graft with in-flow occlusion.
Key words
Internal thoracic artery - Aortoiliac disease - Leg ischemia
