title: Kinking of internal thoracic artery graft without symptoms: should it be revised?
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Kiik
authors.initials: K
authors.lastname: Sung
authors.forename: Ji-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Tae-Gook
authors.initials: TG
authors.lastname: Jun
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery* / Q000637:transplantation; D008875:Middle Aged; D012086:Reoperation; D019737:Transplants / Q000009:adverse effects*