Descending branch of lateral femoral circumflex artery as a free graft for myocardial revascularization: A case report

Abstract

The lateral femoral circumflex artery (LFCA) is one of the branches of the deep femoral artery. In the field of plastic and reconstructive surgery, the LFCA has been used to supply composite tissue of skin and/or muscle. 1-3 The LFCA has three major branches: the ascending, transverse, and descending branches. The descending branch of the LFCA passes downward through the intermuscular space between the rectus femoris muscle and the vastus lateralis muscle and finally terminates in the vastus muscle near the knee joint, The descending branches of the LFCA have a very large diameter (2 to 3 ram) and do not taper like those of the radial arteries. 3 The descending branch of the LFCA has an attractive caliber and length. We report the first case in which a descending branch of the LFCA was used as a graft for myocardial revascularization. A 77-year-old woman had a 7-month history of increasing angina on exertion. ElectrocardiOgraphic changes were consistent with effort angina. Cardiac catheterization revealed a 99% stenosis of the proximal right coronary artery and a 75% stenosis of the middle third of the left anterior descending coronary artery. For this patient, we had planned to perform coronary artery bypass grafting (CABG): a left internal thoracic artery (LITA) in situ to the left anterior descending coronary artery and a saphenous vein graft to the right coronary artery. However, the saphenous vein had varices and was unacceptably thin. We also decided to avoid grafting the right internal thoracic artery to the right coronary artery for this elderly woman because devascularization of the sternum suggested a greater risk of sternal wound infections with the use of bilateral internal thoracic artery grafts. We concluded that the descending branch of the LFCA could be used to bypass the right coronary artery. We had evaluated the descending branches of the LFCA bilaterally by means of a femoral arteriogram 5 days before this operation. The arteriogram showed a good qUality vessel Without stenosis (Fig. 1). The descending branch of the left LFCA was harvested