A 66-year-old man had two coronary arterial lesions. Contrast-enhanced CT revealed inflammatory thickenings around the coronary arteries, the superior mesenteric artery, and the abdominal aorta. Blood testing showed a high serum IgG4 level. Therefore, pericoronary inflammation due to IgG4-related diseases was strongly suspected. Because percutaneous intracoronary stenting might cause coronary aneurysm formation, coronary artery bypass grafting was performed. However, it was difficult to detect IgG4-positive cells of coronary artery wall by histopathological examination. We report the relatively rare IgG4-related pericoronary inflammation treated by coronary artery bypass grafting.
A 47-year-old man underwent enhanced computed tomography for the evaluation of his lumbago. A celiac artery aneurysm (diameter: 27 mm) and a common trunk of the celiac and superior mesenteric arteries were noted. The aneurysm was resected and replaced with a left internal iliac artery graft via medial visceral rotation through midline laparotomy, a procedure that offered an excellent surgical field. We believe that the internal iliac artery is a good graft option for reducing the risk of future graft aneurysm formation, especially in relatively young patients.