Key result
Novel LITA-to-coeliac collateral pathway suggests LITA harvest during CABG may cause acute abdominal ischemia.
Case Report (n=1)
Highlights a rare collateral pathway between the left internal thoracic artery and coeliac artery, warning that LIMA harvest for CABG in such patients could cause acute visceral ischaemia.
LITA-coeliac collaterals may warrant harvest caution; case report extends anatomical variants but leaves clinical impact open.
Collateralisation around stenotic or occlusive arterial disease is a commonly observed adaptation for maintenance of arterial perfusion. It occurs through pathways of well-understood embryological origin. Examples include Winslow's pathway (internal thoracic artery to iliac artery via the epigastric arteries) and the arc of Riolan (between superior and inferior mesenteric arteries). In this article, we describe a pathway of collateralisation around stenotic disease of the coeliac and superior mesenteric arteries in a 76-year-old man with an abdominal aortic aneurysm. The collateral pathway was identified on computed tomography angiography between the left internal thoracic artery in the thorax and the coeliac artery in the abdomen via the left inferior phrenic artery. This has implications for routine cardiac surgery, such that left internal thoracic artery harvest during coronary artery bypass surgery would likely result in acute ischaemia of the abdominal viscera.
No takes yet. Share an insight, caveat, or question.
Patel et al. (2022) conducted a case report in Stenotic disease of the coeliac and superior mesenteric arteries with an abdominal aortic aneurysm (n=1). Collateralisation between the left internal thoracic artery and the coeliac artery was evaluated. A unique collateral pathway between the left internal thoracic artery and the coeliac artery was identified, implying LITA harvest during bypass could cause acute abdominal ischaemia.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: