[HSF] Any One Had This Complication?

[Prasanna Simha M]

This was congenital. (The right IMA was like a pipe)
Prasanna

On Sun, Apr 27, 2008 at 7:20 PM, <Jbflegejr at aol.com> wrote:

> Hal, we had a patient a few years ago, a severe vasculopath with extensive
> PVD and aorto-iliac disease, on whom we did a MIDCAB with the LIMA and a
> few
> hours later she developed small bowel necrosis. We presumed that the LIMA
> was a
> critical source of blood supply to the abdominal viscera. I have an
> angiogram
> in my collection done for coronary disase  with both IMAs injected and
> with
> each injection there was extensive filling of the visceral vessels in the
> upper
> abdomen. I don't know what happened to that patient but  it was a good
> illustration that the IMAs may contribute to the abdominal visceral blood
> supply.
> There was a report in one of the journals several years ago which showed
> an
> arteriogram of the IMA filling the arteries to a lower extremity. I had a
> patient
> who had the right IMA used for a coronary graft and developed a full
> thickness
> infarct of the abdominal wall in the right upper quadrant. A friend of
> mine
> from the west coast told me of a patient with severe peripheral vascular
> disease
> in whom he observed that the LIMA was unusually large and after its use as
> a
> coronary bypass had infarction of the small bowel. It seems pretty clear
> that
> there are some patients in whom the IMA is a critical source of blood
> supply to
> some important structure and when it seems unusually large one should ve
> wary. It might be advisable to have IMA arteriograms to look for something
> downstream that is dependant on the IMA for blood supply, particularly in
> patients
> who have severe peripheral vascular disease. John Flege
>
>
>
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-- 
Prasanna Simha M
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