[HSF] Abnormal LIMA

[psimha]

That is a "traction dissection" due to a friable LIMA and traction  
during dissection. I have seen this a  few times  when I was initially 
dissecting the LIMA but after making a "No traction" policy " I stopped 
having it. Basically  I have seen many people tugging on the LIMA during 
dissection  to get a better view . This causes a tube in tube dissection 
(usually distal where the initial dissection is done). I recently saw  
one by a colleague who was in the LIMA taking down learning curve .
Prasanna
john pj wrote:
> 2 days back we operated  a 54 yr old man for LT main stenosis with lesions in LAD and OM.The LIMA[2.5 mm in size] was harvested with out  any difficulty  and  had good pulsation and flow when divided. When we divided the distal end we noted that the  thick intima was telescoping beyond the remaining layers. When it was cut opened the intima was more opaue  and lacked the lustre of normal intima. The thickened  Intima was sliding against other layers as if they are separated. It was not like dissection. We did not see any localised atherosclerosis plaques .
>   .
>   We exised about 3 cm LIMA and there was no change in teh appearence . We went ahead with LIMA to LAD grafting takinkincare to incluse all the layers cautiously.We are watching the patient closely. We have low threshold to go back to replace it with a vein in case  of any problems in the LAD territory.
>    
> Any comments?
>        
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