• U Hake, C Düber, M Hilker, F X Schmid, and H Oelert.
• Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University, Mainz, Germany.
• Thorac Cardiovasc Surg. 1996 Jun 1; 44 (3): 147-9.

AbstractDuring 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 either the left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA was excluded in order to 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.

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