Spontaneous avulsion of left internal mammary artery graft a complication of coronary artery bypass surgery: case report and review of the literature

• Published in: Journal of cardiothoracic surgery 2024-09, Vol.19 (1), p.527-5, Article 527
• Main Authors: Nairat, Moath, Akram, Hamza, Alaqra, Amro, Al-Khdour, Issa, Othman, Wafiq, Yaghi, Nadine
• Format: Article
• Language: English
• Subjects: Aged; Atrial fibrillation; Avulsion; CABG; Case Report; Coronary artery bypass; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Disease - surgery; Coronary heart disease; Grafts; Health aspects; Humans; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Left internal mammary artery; LIMA; Male; Mammary Arteries - injuries; Mammary Arteries - surgery; Mammary Arteries - transplantation; Postoperative Complications - surgery; Surgery
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-03004-2

Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade. We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.