Percutaneous in situ coronary artery bypass (PICAB) and PICVA

Percutaneous in situ coronary artery bypass (PICAB) and PICVA

Percutaneous in situ coronary artery bypass (PICAB) and PICVA: Percutaneous in situ coronary artery bypass (PICAB) is a technique in which a conduit is created between a proximal coronary artery and a vein in order to supply oxygenated blood to a region of ischemic myocardium. The vein is entered from the artery proximal to the obstruction and the artery is re-entered from the vein distal to the obstruction. This segment of the vein acts as a bypass. The lumen of the vein is plugged before after this segment.

Myocardium is perfused through a coronary vein in a retrograde fashion in another procedure known as PICVA (Percutaneous In situ Coronary Venous Arterialization). In that procedure, a fistula is created from the artery proximal to the obstruction to the coronary vein using a self expanding connector. The proximal vein is plugged off to prevent steal of blood into the coronary sinus. This technique will force retroperfusion of the myocardium through the coronary vein. The procedure has been be done between proximal left anterior descending coronary artery and the anterior interventricular vein to perfuse the anterior wall in a case of diffuse left anterior descending artery disease with no other options [1].

Reference

1. S N Oesterle 1, N Reifart, E Hauptmann, M Hayase, A C Yeung. Percutaneous in situ coronary venous arterialization: report of the first human catheter-based coronary artery bypass. Circulation. 2001 May 29;103(21):2539-43.