Skip to main content
Top
Published in:

Open Access 07-01-2025 | Stable Angina Pectoris | Case Report

Lateral costal artery as a culprit for the steal phenomenon after coronary artery bypass grafting: a case report and review of the literature

Authors: Michal Trebišovský, Marián Homola, Adrián Kolesár, Štefan Lukačin, Anton Bereš

Published in: Journal of Cardiothoracic Surgery | Issue 1/2025

Login to get access

Abstract

Background

The left internal thoracic artery (LITA) has been widely accepted as the standard for revascularizing the left anterior descending artery during coronary artery bypass grafting (CABG) surgery. However, in 10–20% of cases, the LITA may lead to unsecured side branches to the chest wall, particularly the lateral costal artery (LCA), potentially resulting in postoperative chest angina.

Case presentation

We report the case of a 58-year-old patient who experienced persistent angina eight months after having undergone coronary artery bypass grafting (CABG) due to the steal phenomenon caused by a thick lateral costal artery (LCA). The LCA was found to be 2/3 the diameter of the left internal thoracic artery (LITA) with the decision to obliterate the LCA. Following LCA obliteration, the patient’s exertional angina was resolved.

Conclusions

LCA may pose a potential issue in terms of coronary steal after CABG. Understanding the anatomy of the LITA with LCA variation and widening the opening of the pleura may be beneficial in preventing postoperative steal in selected cases.
Appendix
Available only for authorised users
Literature
1.
go back to reference Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314(1):1–6.CrossRefPubMed Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314(1):1–6.CrossRefPubMed
2.
go back to reference Kern MJ. Mammary side branch steal: is this a real or even clinically important phenomenon? Ann Thorac Surg. 1998;66(6):1873–5.PubMed Kern MJ. Mammary side branch steal: is this a real or even clinically important phenomenon? Ann Thorac Surg. 1998;66(6):1873–5.PubMed
3.
go back to reference ALEXANDER WF. The course and incidence of the lateral costal branch of the internal mammary artery. Anat Rec. 1946;94:446.PubMed ALEXANDER WF. The course and incidence of the lateral costal branch of the internal mammary artery. Anat Rec. 1946;94:446.PubMed
4.
go back to reference Rezk ME, Elgazzar MA, Abo Youssef SM, Emeraa AS, Elkafoury AE, Moussa HH. Open Versus Closed Pleura Internal Mammary artery harvesting and early pulmonary function after coronary artery bypass grafting. Heart Lung Circ. 2020;29(9):1412–7.CrossRefPubMed Rezk ME, Elgazzar MA, Abo Youssef SM, Emeraa AS, Elkafoury AE, Moussa HH. Open Versus Closed Pleura Internal Mammary artery harvesting and early pulmonary function after coronary artery bypass grafting. Heart Lung Circ. 2020;29(9):1412–7.CrossRefPubMed
5.
go back to reference Henriquez-Pino JA, Gomes WJ, Prates JC, Buffolo E. Surgical anatomy of the internal thoracic artery. Ann Thorac Surg. 1997;64(4):1041–5.CrossRefPubMed Henriquez-Pino JA, Gomes WJ, Prates JC, Buffolo E. Surgical anatomy of the internal thoracic artery. Ann Thorac Surg. 1997;64(4):1041–5.CrossRefPubMed
6.
go back to reference Bauer EP, Bino MC, von Segesser LK, Laske A, Turina MI. Internal mammary artery anomalies. Thorac Cardiovasc Surg. 1990;38(5):312–5.CrossRefPubMed Bauer EP, Bino MC, von Segesser LK, Laske A, Turina MI. Internal mammary artery anomalies. Thorac Cardiovasc Surg. 1990;38(5):312–5.CrossRefPubMed
7.
go back to reference Calafiore AM, Contini M, Iacò AL, Maddestra N, Paloscia L, Iovino T, Di Mauro M. Angiographic anatomy of the grafted left internal mammary artery. Ann Thorac Surg. 1999;68(5):1636–9.CrossRefPubMed Calafiore AM, Contini M, Iacò AL, Maddestra N, Paloscia L, Iovino T, Di Mauro M. Angiographic anatomy of the grafted left internal mammary artery. Ann Thorac Surg. 1999;68(5):1636–9.CrossRefPubMed
8.
go back to reference Sutherland FW, Desai JB. Incidence and size of lateral costal artery in 103 patients. Ann Thorac Surg. 2000;69(6):1865–6.CrossRefPubMed Sutherland FW, Desai JB. Incidence and size of lateral costal artery in 103 patients. Ann Thorac Surg. 2000;69(6):1865–6.CrossRefPubMed
9.
go back to reference Nakazawa S, Kawatani N, Obayashi K, Ohtaki Y, Ito T, Yajima T, Shirabe K. Clinical and anatomical features of the lateral costal artery and vein. Sci Rep. 2022;12(1):10589.CrossRefPubMedPubMedCentral Nakazawa S, Kawatani N, Obayashi K, Ohtaki Y, Ito T, Yajima T, Shirabe K. Clinical and anatomical features of the lateral costal artery and vein. Sci Rep. 2022;12(1):10589.CrossRefPubMedPubMedCentral
10.
go back to reference Emilio F-C, Oscar I-H. Echeverría-M. Mark. Lateral-bilateral Costal Branch (R. Costalis Lateralis): a clinically relevant Anatomical Variation. Int J Morphol [Internet]. 2017 Dec [cited 2024 Aug 20]; 35(4): 1512–6. Emilio F-C, Oscar I-H. Echeverría-M. Mark. Lateral-bilateral Costal Branch (R. Costalis Lateralis): a clinically relevant Anatomical Variation. Int J Morphol [Internet]. 2017 Dec [cited 2024 Aug 20]; 35(4): 1512–6.
11.
go back to reference Hartman AR, Mawulawde KI, Dervan JP, Anagnostopoulos CE. Myocardial revascularization with the lateral costal artery. Ann Thorac Surg. 1990;49(5):816–8.CrossRefPubMed Hartman AR, Mawulawde KI, Dervan JP, Anagnostopoulos CE. Myocardial revascularization with the lateral costal artery. Ann Thorac Surg. 1990;49(5):816–8.CrossRefPubMed
12.
go back to reference Vural Ü, Aglar AA, Sahin S, Kizilay M. Lateral costal artery: clinical importance of an accessory thoracic artery. Braz J Cardiovasc Surg. 2018 Nov-Dec;33(6):626–30. Vural Ü, Aglar AA, Sahin S, Kizilay M. Lateral costal artery: clinical importance of an accessory thoracic artery. Braz J Cardiovasc Surg. 2018 Nov-Dec;33(6):626–30.
Metadata
Title
Lateral costal artery as a culprit for the steal phenomenon after coronary artery bypass grafting: a case report and review of the literature
Authors
Michal Trebišovský
Marián Homola
Adrián Kolesár
Štefan Lukačin
Anton Bereš
Publication date
07-01-2025
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2025
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-03273-x

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

Keynote webinar | Spotlight on medication adherence

  • Webinar | 27-06-2024 | 18:00 (CEST)

Medication non-adherence is a major barrier to effective healthcare delivery; half of all patients do not follow their doctor’s recommendations or treatment plan.

Our experts explain the fundamentals with a practical discussion of how to manage non-adherence in two common scenarios: hypertension and asthma control.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Watch now