ISPUB.com / IJTCVS/13/2/7668
  • Author/Editor Login
  • Registration
  • Facebook
  • Google Plus

ISPUB.com

Internet
Scientific
Publications

  • Home
  • Journals
  • Latest Articles
  • Disclaimers
  • Article Submissions
  • Contact
  • Help
  • The Internet Journal of Thoracic and Cardiovascular Surgery
  • Volume 13
  • Number 2

Original Article

Kinking of left internal mammary artery graft exhibiting as false coiling entity

U Yetkin, C Özbek, M Bademci, ? Yürekli, M Ye?il, A Gürbüz

Keywords

coiling, kinking, left internal mammary artery graft

Citation

U Yetkin, C Özbek, M Bademci, ? Yürekli, M Ye?il, A Gürbüz. Kinking of left internal mammary artery graft exhibiting as false coiling entity. The Internet Journal of Thoracic and Cardiovascular Surgery. 2008 Volume 13 Number 2.

Abstract

Coiling of the artery is a rare morphologic entity.We describe a case of kinking of left internal mammary artery graft exhibiting as false coiling entity

 

Introduction

Coiling (or looping) of the artery is a rare morphologic entity, most frequently described in the internal carotid artery. In other arteries, coiling is rarely reported because it remains asymptomatic and without clinical relevance unless inadvertently injured, as for diagnostic or monitoring purposes(1). The internal mammary artery is the most frequently used bypass conduit for the left anterior descending coronary artery in patients treated with bypass surgery, with excellent long-term patency rates. However, the mammary artery may also be affected by functionally significant stenoses. Most stenoses of the mammary artery are secondary to the surgical procedure at the anastomosis site, but atherosclerotic lesions may also develop(2).

Case Presentation

Our case was a 43-year-old male. His past medical history was significant for 3-vessel CABG and concomitant mitral ring annuloplasty at a different health facility 4 years ago. He was suffering from chest pain for 3 months. His coronary angiogram revealed stenoses in saphenous venous graft to the right coronary artery, in the native circumflex and left anterior descending arteries at postanastomotic segments. Percutaneous approach was planned for treatment. But during rehospitalization period, he suffered from fever and investigations identified a subacute bacterial endocarditis including the mitral valve (moderate mitral regurgitation and a vegetative mass of 1.9x0.9 cm on atrial face of mitral anterior leaflet). He was then referred to our clinic for re-CABG and mitral valve exploration. His coronary angiogram showed a lesion of left internal mammarian artery graft consistent with coiling at right anterior oblique position (Figures 1&2).

Figure 1
Figure 1

Figure 2
Figure 2

However, this lesion was identified as kinking at left anterior oblique position (Figures 3&4).

Figure 3
Figure 3

Figure 4
Figure 4: No luminal irregularity or indentation was shown

Discussion

Kinking of an ITA graft that's seen on the early postoperative angiography might improve without surgery or intervention. The natural course of ITA graft kinks should be considered when detecting these kinks on the early postoperative angiography when the patient is asymptomatic(3).

Skeletonization of the internal thoracic artery (ITA) has several advantages: sequential bypass grafting can be easily performed, and a graft of increased length can make the distal coronary artery accessible. However, kinking of the grafts has been observed on postoperative angiograms in a few cases(4).

In the study of Imamaki et al.,they investigated whether there were significant differences in the frequency of graft kinking and stenosis degree at the kink site between pedicled and skeletonized grafts. When the ITA had a kink, the stenosis degree at the kink site was significantly higher in the skeletonized group than in the pedicled group(4).

The role of marked bends in bypass grafts could deserve selective studies to determine whether they are associated with the development of functional stenosis. This information may be useful when performing mammary artery bypass graft surgery for avoiding extremely twisted vessel courses(2). Immediate intervention need not always be performed if the patient has no angina caused by a stenotic lesion at the kink site(4).

References

1. Ilijevski NS, Jagodic S, Sagic D, Radak D. Coiling of the brachial artery: an uncommon cause of difficult thrombectomy. Vascular 2005 ;13(4):248-51.
2. Bertona R, De Candia G, Boccuzzi G, Ribichini F, Agostini M, Vassanelli C. Left internal mammary artery graft stenosis. Atherosclerosis, spasm or kinking? Ital Heart J Suppl 2004 ;5(1 Suppl):53-8.
3. Kim WS, Lee YT, Choi JH, Sung K, Yang JH, Jun TG, Park PW. Kinking of internal thoracic artery graft without symptoms: should it be revised? Heart Surg Forum 2007;10(5):E372-5.
4. Imamaki M, Sakurai M, Shimura H, Ishida A, Fujita H, Miyazaki M. Pitfalls of skeletonized internal thoracic artery: comparison of graft kinking between skeletonized and pedicled grafts based on postoperative angiography findings. J Card Surg 2007 ;22(3):195-8.

Author Information

Ufuk Yetkin
Clinic Deputy Chief in Cardiovascular Surgery, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

Cengiz Özbek
Clinic Deputy Chief in Cardiovascular Surgery, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

Mehmet Bademci
Resident in Cardiovascular Surgery, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

?smail Yürekli
Specialist in Cardiovascular Surgery, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

Murat Ye?il
Clinic Chief in I.Cardiology, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

Ali Gürbüz
Clinic Chief in Cardiovascular Surgery, Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital

Your free access to ISPUB is funded by the following advertisements:

Advertisement
BACK TO TOP
  • Facebook
  • Google Plus

© 2013 Internet Scientific Publications, LLC. All rights reserved.    UBM Medica Network Privacy Policy