Inadvertent anastomosis of internal mammary artery to great cardiac vein: a rare complication of coronary artery bypass surgery.
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ABSTRACT:
SUBMITTER: Puri R
PROVIDER: S-EPMC2801931 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. METHODS:Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or "string sign" conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. RESULTS:Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. CONCLUSIONS:All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
| S-EPMC7092416 | biostudies-literature
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| S-EPMC8276319 | biostudies-literature
Project description:BackgroundValdoni technique involves leaving the mucosa layer, between the two anastomosed bowel tract intact, providing for a subsequent breakage of the intestine. It is a technique that allows you to keep the operating field clean.Surgical technique and Case Report: We describe the Valdoni technique. We also report a case of 75 years old man affected by an ascending colon cancer with no metastasis. The patient underwent right hemicolectomy. Making the anastomose, the surgeon did the Valdoni technique, with no intraoperative complications.The postoperative course was characterized by an abdominal pain with swollen abdomen, no flatus and vomit. A computed tomography (CT) revealed a sub-stenosis of the anastomose. We decided to do an urgent colonoscopy, with a resection of the mucosa layer not totally opened, using a Needle-knife Precut. The post procedure course was uneventful. The patient was discharged three days later.ConclusionValdoni technique allows the surgeon to keep the operating field clean. It is a valid alternative when the surgeons have to make a colonic anastomosis, doing open surgery.
| S-EPMC6612045 | biostudies-literature
Project description:Pseudoaneurysms are among very rare complications of maxillofacial trauma. When encountered, they have the potential to cause life-threatening hemorrhage. A wise surgeon should consider the possibility of underlying aneurysm even if the classic sign of pulsatile mass is not present. The role of interventional radiology is immaculate in the management of these aneurysms.
| S-EPMC3820730 | biostudies-other
Project description:BackgroundWhile internal mammary artery (IMA) has become a major conduit of coronary artery bypass graft (CABG) surgery, subclavian artery stenosis (SAS) could cause subsequent coronary events due to ischemia of myocardial territory supplied by IMA. Clinical characteristics and cardiovascular outcomes of SAS-related IMA failure (SAS-IMAF) remain to be fully determined yet. Therefore, the current study was designed to characterize SAS-IMAF in patients receiving CABG with IMA.MethodsThis is a retrospective observational study which analyzed 380 patients who presented acute coronary syndrome/stable ischemic heart disease (ACS/SIHD) after CABG using IMA (2005.01.01-2020.10.31). SAS-IMAF was defined as the presence of myocardial ischemia/necrosis caused by SAS. Clinical characteristics and cardiovascular outcomes [major adverse cardiovascular events (MACE) = cardiac death + non-fatal myocardial infarction + non-fatal ischemic stroke], were compared in subjects with and without SAS-IMAF. Multivariate Cox proportional hazards model and propensity score-matched analyses were used to compare cardiovascular outcomes between those with and without SAS-IMAF.ResultsSAS-IMAF was identified in 5.5% (21/380) of study subjects. Patients with SAS-IMAF are more likely had a history of hemodialysis (P<0.001), stroke (P<0.001) and lower extremity artery disease (P<0.001). Furthermore, SAS-IMAF patients more frequently presented ACS (P=0.002) and required mechanical support (P=0.02). Despite SAS as a culprit lesion causing ACS/SIHD, percutaneous coronary intervention was firstly selected in 47.6% (10/21) of them. Consequently, 33.3% (7/21) of SAS-IMAF patients required additional revascularization procedure (vs. 0.3%, P<0.001). During 4.9-year observational period, SAS-IMAF exhibited a 5.82-fold [95% confidence interval (CI): 2.31-14.65, P<0.001] increased risk of MACE. Multivariate Cox proportional hazards model [hazard ratio (HR) 4.04, 95% CI: 1.44-11.38, P=0.008] and propensity score-matched analyses (HR 2.67, 95% CI: 1.06-6.73, P=0.038) consistently demonstrated the association of SAS-IMAF with MACE.ConclusionsSAS-IMAF reflects a high-risk phenotype of polyvascular disease, underscoring meticulous evaluation of subclavian artery after CABG using IMA.
| S-EPMC10753230 | biostudies-literature
Project description:The aim of this study was to assess the pattern of the adoption of internal mammary artery (IMA) grafting in the United States, test its association with clinical outcomes, and assess whether its effectiveness differs in key clinical subgroups.The effect of IMA grafting on major clinical outcomes has never been tested in a large randomized trial, yet it is now a quality standard for coronary artery bypass graft (CABG) surgery.We identified Medicare beneficiaries ≥66 years of age who underwent isolated multivessel CABG between 1988 and 2008, and we documented patterns of IMA use over time. We used a multivariable propensity score to match patients with and without an IMA and compared rates of death, myocardial infarction (MI), and repeat revascularization. We tested for variations in IMA effectiveness with treatment × covariate interaction tests.The IMA use in CABG rose slowly from 31% in 1988 to 91% in 2008, with persistent wide geographic variations. Among 60,896 propensity score-matched patients over a median 6.8-year follow-up, IMA use was associated with lower all-cause mortality (adjusted hazard ratio: 0.77, p < 0.001), lower death or MI (adjusted hazard ratio: 0.77, p < 0.001), and fewer repeat revascularizations over 5 years (8% vs. 9%, p < 0.001). The association between IMA use and lower mortality was significantly weaker (p ≤ 0.008) for older patients, women, and patients with diabetes or peripheral arterial disease.Internal mammary artery grafting was adopted slowly and still shows substantial geographic variation. IMA use is associated with lower rates of death, MI, and repeat coronary revascularization.
| S-EPMC3947230 | biostudies-other
Project description:BackgroundDonor-recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution.Case presentationA 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery.ConclusionThe triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein.
| S-EPMC9841726 | biostudies-literature
Project description: Not available
| S-EPMC4943885 | biostudies-literature
Project description:Pancreatic ductal injury is rare during choledochal cyst excision. Most cases present in the immediate postoperative period with pancreatic fistula or acute pancreatitis are managed conservatively. But, inadvertent ligation of the main pancreatic duct with subsequent recurrent pancreatitis and upstream dilatation of the pancreatic duct requiring a pancreatic ductal drainage operation has not been reported in the English literature. A 23-year-old female patient presented with recurrent episodes of upper abdominal pain for about 16 months. She had a history of type-1 choledochal cyst excision 18 months back. She was evaluated with abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP). MRCP showed hugely dilated main pancreatic duct with normal hepaticojejunostomy anastomosis. There was no residual cyst. MRCP findings were suggestive of stricture of the main pancreatic duct due to previous surgery. Endoscopic pancreatic ductal decompression failed. The patient was treated successfully with pancreaticogastrostomy. Postoperative recovery was uneventful. The patient was well at 24-month follow-up.
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Project description:Internal carotid artery (ICA) injury following transsphenoidal surgery is a rare but potentially fatal complication. Usually, endovascular occlusion of the ICA or stent graft placement is the treatment of these vascular complications described in literature. We present a case of ICA perforation during transsphenoidal surgery in a patient with limited collateral cerebral blood flow and with ectasia of the ICA that rule out an endovascular treatment. We report the surgical revascularization via high-flow extra-intracranial radial artery bypass and consicutive artery ligation.
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