Complete vascular ring presenting in adulthood: an unusual management dilemma.

elongation. The recycling of ITA grafts can be performed in only a selected redo CABG population, when the ITA is patent but stenotic in the perianastomotic area, when there is a stenosis in the coronary artery distal to the anastomosis, and when an interventional cardiologic approach is not feasible. Preoperative selective angiography of the used ITA is helpful to exclude proximal stenosis, to locate its relationship, and to provide anatomic details that may suggest this possible alternative approach during redo CABG surgery. In conclusion, our limited experience confirmed that the recycling of ITA grafts in redo CABG can produce satisfactory outcomes in selected patients even at long-term follow-up. References 1. Burfeind WR Jr, Glower DD, Wechsler AS, Tuttle RH, Shaw LK, Harrel FE Jr, et al. Single versus multiple internal mammary artery grafting for coronary artery bypass: 15 year follow-up of a clinical practice trial. Circulation. 2004;110(Suppl):II27-35. 2. Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic artery grafts: effects on survival over a 15-year period. N Engl J Med. 1996;334:216-9. 3. Noyez L, Lacquet LK. Recycling of the internal mammary artery in coronary reoperation. Ann Thorac Surg. 1993;55:597-9. 4. Antona C, Parolari A, Zanobini M, Arena V, Biglioli P. Midterm angiographic study of five recycled mammary arteries during four coronary redos. Ann Thorac Surg. 1996;61:702-5. 5. Noirhomme PH, Underwood MJ, El Khoury GA, Glineur D, Elias B, d’Udekem Y, et al. Recycling of arterial grafts during reoperative coronary artery operations. Ann Thorac Surg. 1999;67:641-4.