Diffuse Calcified Coronary Artery Disease Requiring PDA Enda | Figure 1

DrmtzrubioCCV

Diffuse Calcified Coronary Artery Disease Requiring PDA Endarterectomy During On-Pump CABG

A 50-year-old male with long-standing diabetes mellitus, hypertension, and a >30-year smoking history presented with multivessel coronary artery disease on coronary angiography. After Heart Team discussion, the patient was accepted for surgical revascularization.

Given the diffuse and heavily calcified nature of the coronary disease and the high likelihood of requiring coronary endarterectomy, coronary artery bypass grafting was intentionally performed using cardiopulmonary bypass. The strategy aimed to provide optimal myocardial protection and technical control, avoiding the risk of being unable to safely perform endarterectomy in an off-pump setting.

Although the patient was relatively young, a completely arterial revascularization strategy was not pursued. Preoperative Doppler assessment demonstrated structural compromise of both radial arteries, precluding their use as suitable conduits.

Intraoperatively, both the left anterior descending artery (LAD) and the posterior descending artery (PDA) demonstrated severe diffuse calcification. The PDA exhibited advanced obstructive disease requiring coronary endarterectomy to achieve adequate distal runoff.

Images 1: Coronary angiography demonstrating multivessel coronary artery disease.

Images 2–3: Intraoperative view showing severe calcification of both the left anterior descending artery (LAD) and the posterior descending artery (PDA).

Image 4: Posterior descending artery (PDA) endarterectomy performed to restore luminal patency.

Image 5: Extracted calcified atheromatous plaque from the posterior descending artery (PDA) bed.

In diffuse multivessel calcified coronary disease, surgical planning must integrate anticipated endarterectomy requirements and conduit quality. A planned on-pump strategy may provide optimal safety and technical control when complex coronary reconstruction is expected.

Diagnosis added by author

Advanced diffuse multivessel coronary artery disease with severe coronary calcification requiring on-pump CABG and posterior descending artery endarterectomy