Steal phenomenon with kinked graft caused a loss of viability in a dialysis patient.
A 74-year-old man with chronic renal failure under hemodialysis via the left upper extremity underwent an off-pump coronary artery bypass (OPCAB). The left internal thoracic artery (LITA), which was harvested in a skeletonized manner, was anastomosed to the left anterior descending artery (LAD). Postoperatively, he complained of chest pain only during dialysis. Angiography revealed a kinking in the LITA. However, myocardial scintigraphy revealed no ischemia. One year after OPCAB, left ventriculography revealed akinesis and myocardial scintigraphy revealed no viability in the anterior wall. This suggested that the viability was lost due to graft kinking and steal phenomenon during hemodialysis. If the length of the skeletonized ITA graft is redundant, kinking of the graft rarely occurs after the chest is closed. We also suggest that to avoid the kinking of the ITA graft, fibrin glue should be used to paste the ITA graft running in a gentle curve.
Division of Cardiovascular Surgery, Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. imamaki-cuh@umin.ac.jp
Mizuho
M
Imamaki
Atsushi
A
Ishida
Hitoshi
H
Shimura
Masaru
M
Miyazaki
D000368:Aged; D000714:Anastomosis, Surgical; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008323:Mammary Arteries / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects*; D013349:Subclavian Steal Syndrome / Q000209:etiology*