What specific findings on preoperative imaging may increase CABG complexity, such as aortic atherosclerosis?

• A. Extensive aortic atherosclerosis or heavily calcified aorta increases embolic risk; may necessitate off-pump techniques or alternative anastomosis strategies.
• B. Aorta is always normal
• C. Mild calcification suffices
• D. Atherosclerosis of peripheral arteries only

Answer: (A)

The key idea here is how preoperative imaging of the aorta guides how complex the CABG plan will be. When imaging shows extensive aortic atherosclerosis or a heavily calcified aorta, the aorta becomes a major source of risk during surgery. Manipulating a diseased aorta—through cannulation, clamping, or proximal anastomoses—can dislodge plaque and send emboli to the brain or other organs, increasing the chance of stroke or malperfusion. That risk pushes the team to modify the approach to minimize aortic handling.

Because of that, surgeons may opt for techniques that avoid touching or limiting manipulation of the aorta. Off-pump CABG is one route, where the heart is repaired without stopping the heart and without aortic cross-clamping. Another is a no-touch or minimal-manipulation strategy, using grafts and proximal anastomoses that avoid the diseased segment, or using alternative cannulation sites if CPB is required. These choices can extend planning time and complexity and require specific skills and grafting strategies.

By contrast, a normal-appearing aorta or only mild calcification presents far less risk from aortic manipulation, so the need for these complex strategies is much lower. And knowing that peripheral arteries are diseased doesn’t by itself capture the risk from the aorta, which is central to this consideration.