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Ann Thorac Surg 2004;77:379
© 2004 The Society of Thoracic Surgeons

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Correspondence

Reply

Division of Cardiovascular Surgery, Toyonaka Municipal Hospital, 14-1, 4-Chome, Shibahara-cho, Toyonaka, Osaka 560-8565, Japan

e-mail: h-kato{at}chp.toyonaka.osaka.jp

To the Editor:

We greatly appreciate the comments of Bonde and Campalani on our case report [1]. Dacey and associates [2] reported the results of their study of a large number of patients with and without preoperative dialysis-dependent renal failure undergoing isolated coronary artery bypass grafting. The actuarial 5-year survival rate was 83.5% for patients without renal failure and 55.8% for patients with dialysis-dependent renal failure. The authors did not conduct a detailed examination of the causes of death after coronary artery bypass grafting. We are concerned that more patients than expected may die as a result of internal mammary artery (IMA) steal on the same side as the arteriovenous fistula both early and late after coronary artery bypass grafting. As Bonde and Campalani pointed out for patients requiring long-term dialysis who may need additional arteriovenous fistulas in the future, we must consider carefully what kind of coronary conduit to use.

The report by Crowley and colleagues [3] confirms our misgivings. Schenk and co-workers [4] demonstrated in dogs that the blood flow through the arteriovenous fistula increased with time. We suppose that the patient in the report of Crowley and associates experienced no angina immediately after construction of the arteriovenous fistula because the initial flow volume was not high. However, it increased with time, thus causing IMA steal during hemodialysis. Therefore, we recommend that with an arteriovenous fistula high flow volume for example, a bridge fistula with an artificial graft or proximal fistula in the upper extremity, should not be constructed in patients after coronary artery bypass grafting using the ipsilateral IMA.

References

1. Kato H., Ikawa S., Hayashi A., Yokoyama K. Internal mammary artery steal in a dialysis patient. Ann Thorac Surg 2003;75:270-271.[Abstract/Free Full Text]
2. Dacey L.J., Liu J.Y., Braxton J.H., et al. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 2002;74:458-463.[Abstract/Free Full Text]
3. Crowley S.D., Butterly D.W., Peter R.H., Schwab S.J. Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula. Am J Kidney Dis 2002;40:852-855.[Medline]
4. Schenk W.G., Jr, Martin J.W., Leslie M.B., Portin B.A. The regional hemodynamics of chronic experimental arteriovenous fistulas. Surg Gynecol Obstet 1960;110:44-50.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hiroshi Kato Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kato, H. Articles by Ikawa, S. Search for Related Content PubMed Articles by Kato, H. Articles by Ikawa, S.