Abstract
Background: The left internal mammary artery (IMA) is widely used as a conduit for coronary revascularization. The incidence of atherosclerosis is known to be lower in the IMA than in the coronary artery. The aim of this study was to evaluate the reliability of the use of the distal section of the IMA as an anastomotic site for bypass grafting and morphometric studies of IMA in patients with proven coronary artery disease and their associated risk factors. Methods: Patients who underwent Coronary Artery Bypass Graft (CABG) from June 2010 to November 2012 were chosen in this retrospective study and the discarded distal segments of the internal mammary artery were analyzed. The potential risk factors for atherosclerosis considered were age, sex, diabetes mellitus, history of cigarette smoking, hypertension and hypercholesterolemia. The samples were analyzed for the degree of intimal thickening and atherosclerosis by calculating the percentage of Luminal Narrowing, Intimal Thickness Index (ITI) and Intima-to-Media Ratio (IMR). Results: There were seven cases of intimal hyperplasia and two cases of focal medial and intimal hyperplasia with fatty streak and no cases of atherosclerosis and medial calcification. ITI was higher in males when compared to females. There was a strong relationship between IMR and smokers when compared to nonsmokers. Conclusion: In our study, when ITI was used as the dependent variable, diabetes was the most important factor. When IMR was used, the strongest predictor was hypercholesterolemia. There was a strong relationship between IMR and smokers when compared to nonsmokers.
Highlights
For over a decade, the survival benefit of the use of the left internal mammary artery (IMA) for patients undergoing coronary re-vascularization has been well established
There was no significant difference in the percentage of luminal narrowing, Intimal Thickness Index (ITI) and Intima-to-Media Ratio (IMR) between the presence of DM, HTN, dyslipidaemia and alcoholic
The results indicate minimal relationship between known risk factors and extent of atherosclerosis in the ITA
Summary
The survival benefit of the use of the left internal mammary artery (IMA) for patients undergoing coronary re-vascularization has been well established. Because of variability in structure and reactivity along its downstream course, selection of the anastomotic site at the distal end of this artery may have some disadvantages He et al have shown that the distal section of the IMA has the highest reactivity along its full length and it is the part where the spasm may develop [10]. The aim of this study was to evaluate the reliability of the use of the distal section of the IMA as an anastomotic site for bypass grafting and morphometric studies of IMA in patients with proven coronary artery disease and their associated risk factors. Methods: Patients who underwent Coronary Artery Bypass Graft (CABG) from June 2010 to November 2012 were chosen in this retrospective study and the discarded distal segments of the internal mammary artery were analyzed. There was a strong relationship between IMR and smokers when compared to nonsmokers
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