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Ann Thorac Surg 2002;73:349-350
© 2002 The Society of Thoracic Surgeons

Correspondence

Is "steal" present in hemodialysis patients with ipsilateral internal mammary graft?

Frank A. Baciewicz, Jr, MDa, Richard J. Harris, MDa

a Cardiothoracic Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA

To the Editor

I enjoyed the recent article by Dr Nakayama and associates [1]. The article details use of the internal mammary artery for coronary revascularization in hemodialysis patients.

Our institution has a large experience with coronary bypass in patients on hemodialysis. We have had concern about a "steal" phenomenon during dialysis from the left internal mammary when the hemodialysis access (AV fistula) is in the left upper extremity. Several reports of myocardial ischemia when intercostal branches have not been taken down during mobilization of the left internal thoracic artery have sparked this concern.

However, because of excellent long-term internal mammary patency, increased survival with the left internal mammary, and the decreased availability of saphenous vein graft in dialysis patients, we have utilized the left internal mammary in patients with left AV fistulae.

Two recent patients with their hemodialysis access in the left upper extremity had the left internal mammary artery placed to the left anterior descending. These patients received thallium during hemodialysis and were studied immediately after. When compared with rest thallium studies, these postdialysis scans did not demonstrate any change in myocardial uptake of the nuclear marker.

Have you noted any myocardial ischemia during hemodialysis in the coronary distribution supplied by the ipsilateral internal mammary?

References

  1. Nakayama Y., Sakata R., Ura M. Bilateral internal thoracic artery use for dialysis patients: does it increase operative risk?. Ann Thorac Surg 2001;71:783-787.[Abstract/Free Full Text]



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