Revascularización arterial total con arteria mamaria interna izquierda

Abstract

A 65-year-old male patient, with a history of insulin dependent diabetes mellitus, hypertension, ischemicheart disease and smoking, underwent a coronary angiography that showed proximal and distal lesions in the left anterior descending artery, and proximal in the diagonal branch (Panel A, arrows). It was decided to perform a coronary artery bypass graft surgery, on a beating heart, without the use of cardiopulmonary bypass. The left internal mammary artery (LIMA) was dissected, skeletonized, to obtain its maximum length and preserve sternal perfusion (Panel B, the left arrow shows the preserved mammary vein and the right arrow the skeletonized LIMA). Sequential grafts were performed: first a laterolateral anastomosis to the first diagonal artery, and then, by jumps, a laterolateral anastomosis to the middle segment of the anterior descending artery. Finally, an endside anastomosis to the distal segment of the anterior descending artery was performed, achieving complete arterial revascularization with the use of a LIMA (Panel C, the clamps show the site of the three sequential grafts). Six months later, the patient continued showing a satisfactory outcome.Paciente masculino de 65 años de edad, con antecedentes de diabetes mellitus insulino-dependiente, hipertensión arterial, cardiopatía isquémica y hábito de fumar, al que se le realiza un estudio coronariográfico y se evidencian lesiones proximal y distal de la arteria descendente anterior y proximal en su ramo diagonal