Spontaneous Avulsion of Left Internal Mammary Artery Graft a Complication of Coronary Artery Bypass Surgery: Case Report and Review of the literature.

Abstract Background: 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 lead to 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. Case presentation: We present a unique case of spontaneous avulsion of LIMA graft to left anterior descending artery (LAD) away from the site of anastomosis twenty-four hours following CABG surgery in 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed, which successfully stabilized the patient critical condition followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. Conclusion: Avulsion of LIMA graft following CABG is rare, however a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported few times in the literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.