EC Pulmonology and Respiratory Medicine

Pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are seldom seen. Several cases were reported with different cause of pseudoaneurysm various from traumatic chest injuries, post CABG or post none CABG cardiac surgeries due to injuries of LIMA or its branches during sternal closure.

Typically, they are asymptomatic and usually presented as an accidentally finding during imaging. However, it could be associated with serious complication of rupture and hemodynamic instability. Management may differ according to the cause and timing of presentation. Urgent intervention either surgical correction or interventional shall be can be the considered soon after diagnosis, they are suitable choices.

This article presents a case of a 65-year-old gentleman with a left IMA branch pseudo aneurysm, early postoperative after CABG surgery. We discuss the decision- making process, recommend a management algorithm, and detail the successful surgical repair.

 Keywords: CABG Complication; Pseudoaneurysm; Internal Mammary Artery Injury

1. LW Chan and GG Fermanis. “Spontaneous hemothorax caused by an internal mammary artery aneurysm”. The Australian and New Zealand Journal of Surgery5 (1996): 332-333.
2. JT Connell. “Saphenovenous graft aneurysm: a rare complication of CABG”. Case Reports in Cardiology (2017): 8101489.
3. A Frazier., et al. “Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings”. Radiographics4 (2005): 881-896.
4. GD Otter and J Stam. “Aneurysm of internal mammary artery”. Thorax 4 (1978): 526-527.
5. M Miyazaki., et al. “Successful treatment of a right internal mammary artery aneurysm with thoracoscopic surgery”. Journal of Vascular Surgery Cases and Innovative Techniques3 (2019): 269-272.
6. D Ramirez., et al. “Natural history and management of aortocoronary saphenous vein graft aneurysms”. Circulation18 (2012): 2248-2256.
7. Lawani O., et al. “Incidental finding and endovascular repair of a left internal mammary artery aneurysm following a multivessel coronary artery bypass graft”. Case Reports in Cardiology (2021): 8831235.
8. T Kugai and M Chibana. “Non-trauma-induced aneurysm of the left internal thoracic artery with ischemic heart disease-a case report and review of the literature”. Japan Journal of Cardiovascular Surgery4 (1999): 260-263.
9. T Almerey., et al. “Idiopathic internal mammary artery aneurysm in the setting of aberrant right subclavian artery”. Journal of Vascular Cases and Innovative Techniques4 (2017): 251-253.
10. R Lindblom., et al. “Even small aneurysms can bleed: a ruptured small idiopathic aneurysm of the internal thoracic artery”. Interactive Cardiovascular and Thoracic Surgery3 (2013): 583-585.
11. Mohamed Alassal., et al. “Accidently discovered big basal left ventricular pseudoaneurysm: Case report”. Journal of Molecular and Cellular Cardiology2 (2017): 6.