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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old Caucasian male with a history of coronary artery bypass grafting &#40;CABG&#41; &#91;internal mammary artery &#40;IMA&#41; graft to the left anterior descending artery &#40;LAD&#41; and saphenous vein graft to right posterior descending artery &#40;PDA&#41;&#93;&#44; presented with stable angina with a positive treadmill exercise test&#46; Coronary angiography &#40;CAG&#41; documented occlusion of both middle LAD and IMA grafts &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel A&#41;&#59; no significant lesions were found in the circumflex artery or the saphenous vein graft&#46; The CAG performed prior to surgery is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">After a myocardial perfusion scintigraphy confirming viability in LAD territory&#44; an angioplasty was performed&#46; A new large vessel was visible after mid-LAD dilatation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel B&#44; supplementary film 1&#41;&#46; The images were suggestive of a fistula or a shunt&#46; A 4&#46;0&#215;18-mm drug-eluting stent was successfully implanted&#46; The patient remained stable throughout the procedure&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">CT angiography showed a fistula from the middle segment of the LAD to the coronary sinus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel C&#41;&#46; Excluding the fistula by implanting a covered stent was then considered&#46; However&#44; when performing the initial CAG&#44; complete stent restenosis had occurred&#44; resulting in both LAD and fistula occlusion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; A silent infarction had probably occurred&#46; A new ischemia test was performed&#44; documenting necrosis without viability&#46; A conservative approach was therefore chosen&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Coronary artery fistulas &#40;CAFs&#41; are uncommon&#46; Acquired fistulas are even rarer&#44; and may occur after cardiac trauma&#44; angioplasty&#44; endomyocardial biopsies or cardiac surgery&#46; We describe the rare case of fistula development after CABG&#46; Although the majority of patients are asymptomatic&#44; they can present with angina pectoris or myocardial infarction&#46; In this particular case&#44; due to steal phenomenon&#44; this acquired CAF may have led to both IMA graft and LAD occlusion&#46; Treatment should be considered for symptomatic patients or documented ischemia&#46; Options range from a conservative approach to coil embolization&#44; PTFE stent deployment or surgery&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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