Myocardial ischemia caused by postoperative malfunction of a patent internal mammary coronary arterial graft

Granke, K., Van Meter, C. H., White, C. J., Ochsner, J. L. and Hollier, L. H. (1990). Myocardial ischemia caused by postoperative malfunction of a patent internal mammary coronary arterial graft. In: 13th Annual Meeting of the Midwestern Vascular Surgical Society, Chicago, IL, United States, (659-664). 29-30 September 1989. doi:10.1067/mva.1990.19228


Author Granke, K.
Van Meter, C. H.
White, C. J.
Ochsner, J. L.
Hollier, L. H.
Title of paper Myocardial ischemia caused by postoperative malfunction of a patent internal mammary coronary arterial graft
Conference name 13th Annual Meeting of the Midwestern Vascular Surgical Society
Conference location Chicago, IL, United States
Conference dates 29-30 September 1989
Journal name Journal of Vascular Surgery   Check publisher's open access policy
Place of Publication Philadelphia, PA, United States
Publisher Mosby
Publication Year 1990
Sub-type Fully published paper
DOI 10.1067/mva.1990.19228
ISSN 0741-5214
Volume 11
Issue 5
Start page 659
End page 664
Total pages 5
Language eng
Abstract/Summary The internal mammary artery is used with increasing frequency for myocardial revascularization. However, preoperative coronary angiography does not always provide adequate visualization of subclavian arteries. If a proximal subclavian artery stenosis exists or develops in a patient who has myocardial revascularization with the internal mammary artery, graft malfunction can occur resulting in myocardial ischemia. We have identified four cases of internal mammary artery graft malfunction at our own institution and identified an additional 12 cases from the literature. These 16 cases are analyzed for age, sex, time of onset of symptoms, clinical findings, method of revascularization, and long-term follow-up. Sixty-three percent of the patients were men, and the mean age was 52.9 +/- 9.0 years. Onset of symptoms occurred after a mean interval of 25.1 months from the time of myocardial revascularization. Three patients had asymptomatic reversal of flow in the internal mammary artery as diagnosed by coronary arteriography during routine follow-up examination before 1980. One death after internal mammary artery-coronary bypass grafting was related to immediate malfunction. In the remaining 12 patients with symptomatic malfunction, all but one were treated by placement of a carotid-subclavian bypass graft with no mortality. Relief of myocardial ischemia was complete in 93% of the patients with a mean follow-up of 29.3 months. Carotid-subclavian bypass grafting appears to be the treatment of choice for the usual management of internal mammary artery graft dysfunction. Careful preoperative evaluation and postoperative follow-up of the subclavian arteries, even by simple comparison of bilateral arm blood pressure should help reduce the incidence of this syndrome.
Q-Index Code E1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Conference Paper
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 20:22:00 EST