[HSF] Abnormal LIMA

[Donald Ross]

Yes!!
You know all , I have seen it recently and had to discard half the ima!
I will have to read the "no traction" riot act to my fellows, one of  
whom is hoping to practice in your city next year.
Thanks,
Don

> 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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