Case report
Pseudoxanthoma elasticum: is the left internal mammary artery a suitable conduit for coronary artery bypass grafting?

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Abstract

Coronary artery revascularization remains a feasible and beneficial treatment for coronary artery disease in patients with pseudoxanthoma elasticum. Careful angiographic evaluation of the left internal mammary artery and coronary arteries is required in patients with pseudoxanthoma elasticum with suspected coronary artery disease. A nonstenosed left internal mammary artery at angiography may be used as a conduit for coronary artery revascularization; however, both the effect of harvest and anastomosis on the disease process in the left internal mammary artery and the long-term patency of left internal mammary artery grafts remain unknown.

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Comment

Pseudoxanthoma elasticum is characterized by deranged elastic fiber metabolism and synthesis, resulting in fragmentation and calcification of elastic fibers, with resultant changes in the skin, eyes, gastrointestinal tract, and cardiovascular system [7].

Cardiovascular complications are common and result from elastic fiber degeneration and calcification of the internal elastic lamina of medium-sized arteries. Cardiovascular complications include premature coronary artery disease, cerebrovascular

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Cited by (11)

  • Evaluation of Arterial Grafts Prior to Coronary Bypass in Pseudoxanthoma Elasticum

    2011, Heart Lung and Circulation
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    Subsequent histological evaluation confirmed advanced changes consistent with PXE [4]. In contrast, we have previously described a 21 year-old patient with PXE who underwent CABG using only saphenous vein grafts [5]. At subsequent angiography both in situ IMAs were free of disease.

  • Peripheral Vascular Disease in an Individual with Pseudoxanthoma Elasticum

    2007, European Journal of Vascular and Endovascular Surgery
    Citation Excerpt :

    The majority of information available for PXE related arteriopathies is described in relation to cardiothoracic procedures. There have been many cases that have highlighted the need for individuals undergoing bypass grafting, and potentially having PXE to undergo arterial studies prior to surgery.3–5 Occlusive peripheral vascular disease relating to connective tissue disorders is rarely discussed in the literature.

  • Long-term left internal mammary artery graft patency for coronary artery disease associated with pseudoxanthoma elasticum

    2004, Annals of Thoracic Surgery
    Citation Excerpt :

    The predilection of this pathologic process for medium-sized arteries has led some authors to recommendation that the use of internal mammary artery conduits be avoided altogether during CABG [2, 4, 6, 7]. Recently, this sentiment has come under question, as the LIMA has been found to be free of stenosis in a number of patients being considered for CABG [2, 4, 8]. The effect of harvesting and anastomosis on the disease process within the LIMA has been unclear and has led to continued debate regarding the usefulness of this graft in the treatment of PXE-related coronary artery disease [8].

  • Pseudoxanthoma elasticum

    2017, Orphanet Journal of Rare Diseases

  • The vascular phenotype in pseudoxanthoma elasticum and related disorders: Contribution of a genetic disease to the understanding of vascular calcification

    2013, Frontiers in Genetics

  • Is internal mammary artery suitable for coronary artery bypass graft in pseudoxanthoma elasticum?

    2012, Turkish Journal of Thoracic and Cardiovascular Surgery
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Copyright © 2002 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.