Left Chest Wall Necrosis Following Harvesting the Left Internal Thoracic Artery

Koh Murayama

Fumitaka Isobe

Hirotaka Watanuki and Yasuhiro Futamura

（Department of Cardiovascular Surgery, Aichi Medical University, Aichi, Japan）

A 53-year-old man who complained of chest pain was admitted. He had been on hemodialysis for chronic renal failure since age 34 and suffered from painful abdominal skin ulcer of unknown etiology when he was 49 years old. His coronary angiography showed severe coronary stenosis on the left main trunk and triple vessels. Preoperative CT revealed severe systemic vascular calcification. He underwent coronary artery bypass grafting using the left internal thoracic artery and saphenous vein grafts. Postoperatively, his left anterior chest wall changed into the painful necrosis. On the 43rd postoperative day, VAC therapy was started after the debridement of necrotizing tissue. Histological examination confirmed that it was ischemic necrosis due to stenosis of the vascular lumen with medial calcification and intimal hyperplasia resembling “calciphylaxis”. Performing the sternal excision and skin grafting for the sternal dehiscence, he was discharged on the 148th postoperative day with perfect healing of the chest wall. The calciphylaxis was suspected to be the cause of this rare complication. Therefore, we should consider this matter carefully whenever we harvest the internal thoracic artery for patients who undergo coronary bypass grafting and who require hemodialysis for chronic renal failure.

 

Jpn. J. Cardiovasc. Surg. 44:121-124（2015）

Keywords：coronary artery bypass grafting;chest wall necrosis;calciphylaxis