Suraj Wasudeo Nagre*
Department of CVTS, Grant Medical College, Mumbai, India
Received: 16 June, 2016; Accepted: 27 June, 2016; Published: 29 June, 2016
Dr. Suraj Wasudeo Nagre, 31,Trimurti Building, J J Hospital Compound, Byculla, Mumbai, India, Pin: 400008, Tel: 09967795303; E-mail:
Nagre SW (2016) Long Segment Left Anterior Descending Endarterectomy [10 cm] and its Reconstruction Using Left Internal Thoracic Artery. J Cardiovasc Med Cardiol 3(1): 023-025. DOI: 10.17352/2455-2976.000025
© 2016 Nagre SW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Coronary artery bypass surgery; Coronary artery disease; Left anterior descending artery
Although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel, it has not been widely used. In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Here, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy and its early clinical and angiographic assessment.
Recently, the use of percutaneous coronary intervention (PCI) for treatment of coronary artery disease has progressively increased. A large number of simple stenoses in one or two coronary vessels can be treated by PCI. Therefore, the number of high-risk and severely diseased patients referred for coronary artery bypass grafting (CABG) has been relatively increasing. Coronary endarterectomy has been used to treat severely or diffusely diseased coronary arteries since the 1950s . More recently, the benefits of endarterectomy for the left anterior descending artery (LAD) have gradually become recognized because surgical techniques and technologies have evolved. The greatest advantage of endarterectomy is that the myocardium supplied by the side branches (diagonal branches and septal perforators) of a diffusely diseased LAD can be relieved of ischemia. This advantage cannot be obtained using a conventional graft to the distal LAD alone because this is beyond the diffusely diseased segments.
In coronary artery bypass grafting (CABG), the left anterior descending artery (LAD) and the left internal thoracic artery (LITA) are the best combination with respect to both long-term patency and clinical outcomes. Use of left internal thoracic artery to bypass left anterior descending artery is associated with long term patency and event free survival. Herein, we report a case of long segment revascularisation of a diffusely diseased LAD using the LITA after endarterectomy.
A 54-year-old male with hypertension and non-insulin-dependent diabetes was admitted to our hospital for exertional chest discomfort. He had a history of acute myocardial infarction six weeks previously. A preoperative angiogram showed that he had double vessel disease with a diffusely diseased LAD showing severe proximal stenosis (Figure 1A). Echocardiography revealed regional wall motion abnormalities in the LAD and the left circumflex artery territories and mild left ventricular systolic dysfunction (left ventricular ejection fraction=45%).
- Bailey CP, May A, Lemmon WM (1957) Survival after coronary endarterectomy in man. J Am Med Assoc 164: 641–646.
- Fukui T, Takanashi S, Hosoda Y (2005) Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg 80: 2098-2105.
- Takanashi S, Fukui T, Miyamoto Y (2008) Coronary endarterectomy in the left anterior descending artery. J Cardiol 52: 261–268.
- Kato Y, Shibata T, Takanashi S, Fukui T, Ito A, Shimizu Y (2012) Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery. Ann Thorac Surg 93: 1195–1200 .
- Myers PO, Tabata M, Shekar PS, Couper GS, Khalpey ZI, et al. (2012) Extensive endarterectomy and reconstruction of the left anterior descending artery: early and late outcomes. J Thorac Cardiovasc Surg 143: 1336–1340 .
- Ryu GM, Kim SH, Park SS, Ryu JO, Seo PW (2006) Onlay patch coronary angioplasty with autologous saphenous vein. Korean J Thorac Cardiovasc Surg 33: 512–517 .
Follow us on Academia.edu
Access denied for user 'root'@'localhost' (using password: YES)