Kinking of Internal Thoracic Artery Graft without Symptoms: Should It Be Revised?

Authors

  • Wook Sung Kim
  • Young Tak Lee
  • Jin Ho Choi
  • Kiik Sung
  • Ji-Hyuk Yang
  • Tae-Gook Jun
  • Pyo Won Park

DOI:

https://doi.org/10.1532/HSF98.20071039

Abstract

Background. Surgery or intervention therapy has been performed to correct kinks of internal thoracic artery (ITA) grafts. The aim of this study was to evaluate the natural course of the ITA graft kink and to clarify whether surgery or intervention therapy should be performed in asymptomatic patients during the early postoperative period.

Methods. We investigated the early and follow-up angiographic results of ITA graft kinks in 7 consecutive patients who did not undergo surgical or interventional correction. The graft diameter and percentage of diameter stenosis at the kink site were compared between the early postoperative angiography and the follow-up angiography.

Results. Early postoperative angiography revealed that the diameter stenosis at the kink site was 60.1% ± 6.9% (range, 51 to 69) and the diameter at the kink site was 0.92 ± 0.20 mm (range, 0.63% to 1.25%). The ITA kinks disappeared in all the patients and the diameter of the ITA graft adjacent to the kink was not significantly changed on the follow-up angiography. No luminal irregularity or indentation was shown. All the patients had been free from cardiac events until the follow-up angiography.

Conclusion. 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.

References

Brenot P, Mousseaux E, Relland J, Gaux JC. 1988. Kinking of internal mammary grafts: report of two cases and surgical correction. Cathet Cardiovasc Diagn 14:172-4.nCetindag IB, Quin JA, Grasch AL, Hazelrigg SR. 2003. Thoracotomy for correction of a kinked right internal mammary artery graft. Ann Thorac Surg 75:1655.nGoldstein JA, Safian RD, Aliabadi D, et al. 1998. Intraoperative angiography to assess graft patency after minimally invasive coronary bypass. Ann Thorac Surg 66:1978-82.nImamaki M, Ishida A, Shimura H, Miyazaki M. 2005. Steal phenomenon with kinked graft caused a loss of viability in a dialysis patient. J Card Surg 20:377-9.nIzumi C, Hayashi H, Ueda Y, et al. 2005. Late regression of left internal thoracic artery graft stenosis at the anastomotic site without intervention therapy. J Thorac Cardiovasc Surg 130:1661-7.nKollar A, Simonton CA, Thomley AM, Selle JG. 1996. Balloon angioplasty of the internal mammary artery trunk for early postoperative ischemia: a case report. Cathet Cardiovasc Diagn 37:49-51.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nLytle BW, Loop FD. 2001. Superiority of bilateral internal thoracic artery grafting: it's been a long time comin'. Circulation 104:2152-4.nLytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. 1985. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 89:248-58.nPeterson MD, Borger MA, Rao V, Peniston CM, Feindel CM. 2003. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. J Thorac Cardiovasc Surg 126:1314-9.nRerkpattanapipat P, Ghassemi R, Ledley GS, et al. 1999. Use of stents to treat kinks causing obstruction in a left internal mammary artery graft. Catheter Cardiovasc Interv 46:223-6.nRidderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. 2001. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20:1168-75.n

Published

2007-09-13

How to Cite

Kim, W. S., Lee, Y. T., Choi, J. H., Sung, K., Yang, J.-H., Jun, T.-G., & Park, P. W. (2007). Kinking of Internal Thoracic Artery Graft without Symptoms: Should It Be Revised?. The Heart Surgery Forum, 10(5), E372-E375. https://doi.org/10.1532/HSF98.20071039

Issue

Section

Articles

Most read articles by the same author(s)