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Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 57-59

The fate of a composite arterial graft in a 58-year-old man having strong comorbidities and atherosclerotic burden

Division of Cardiac Surgery, Department of Cardio-Thoracic and Vascular, Trieste University Hospital, Trieste, Italy

Correspondence Address:
Dr. Giuseppe Gatti
Division of Cardiac Surgery, Ospedale di Cattinara, via Pietro Valdoni, 7 - 34148 Trieste
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/rcm.rcm_21_17

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For some difficult subsets of coronary patients having specific comorbidities, such as insulin-dependent diabetes and chronic renal failure, arterial myocardial revascularization could be a satisfactory option. The key question is which arteries should be used. A 58-year-old insulin-dependent diabetic patient with severe renal failure, despite previous kidney transplantation, underwent treatment of his severe and diffuse coronary disease using a composite arterial Y-graft and saphenous vein. Both internal thoracic arteries were harvested as skeletonized conduits. The patient's hospital course was totally uneventful. Fifty-six months later, the patient underwent hospital readmission due to a new (inferior) myocardial infarction. Coronary angiography showed both the progression of disease into the native vessels and occlusion of the venous graft. The Y-graft was patent and well functioning despite the presence of a preoperative left upper limb dialysis fistula. This case report emphasizes the concept that both internal thoracic arteries seem to be refractory to most aggressive forms of atherosclerosis, and that a more liberal use even for high-risk candidates could be a rational practice. However, many surgeons consider the use of both internal thoracic arteries for myocardial revascularization as a too risky strategy that has to be adopted only for young and low-risk patients.

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