The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

Abstract

Background Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. Methods We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within 30 days of surgery, stroke and acute kidney disease (AKD). Results The study population consisted of 1961 patients. The LITA procedure was performed in 1768 patients whereas 193 patients underwent a BITA technique. The estimate of ALLI was 14% higher in the BITA compared to the LITA (p < 0.001) group. Thirty-day mortality, cardiac death, occurrence of stroke and AKI did not differ significantly between the groups. Conclusions The use of both ITAs led to a significant increase in ALLI. This result was most likely caused by the complete disruption of the ITA collateral providing additional blood supply to the lower extremities. Based on our data, BITA should be used with extreme caution in PAD patients. Further research on this topic is necessary to confirm our findings.

Deep inferior epigastric artery as a collateral pathway to the lower extremities: A case report

“…Several studies have reported lower extremity ischemia in patients in whom the internal thoracic artery was harvested for coronary artery grafting. 3 , 4 , 5 , 6 Lower extremity ischemia is a known serious complication of internal thoracic artery harvesting 7 ; studies have reported that lower extremity bypass surgery should be performed before harvesting the internal thoracic artery to prevent the aforementioned complication. 8 , 9 , 10 To our knowledge, only a single report has described lower extremity ischemia secondary to harvesting the deep inferior epigastric artery, which was used as a free rectus abdominis myocutaneous flap, 11 and lower extremity ischemia is not a known complication of inferior epigastric artery harvesting.…”

Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part IІ

“…Аналіз Micali et al продемонстрував, що у пацієнтів із ЗПА після вінцевого шунтування на 14 % вище ризик виникнення гострої ішемії нижніх кінцівок у разі бімамарного шунтування при порівнянні з використанням лише лівої внутрішньої грудної артерії (p < 0,001) [36].…”