Anomalous origin of a grafted left internal mammary artery from the deep brachial artery

A 58-year-old patient underwent coronary bypass surgery; the left internal mammary artery (LIMA) was directed to the left anterior descending artery (LAD). Postoperative course was uneventful. Two months later, the patient went to his family doctor for a routine control. During the visit, blood pressure was measured by placing the cuff around his left arm. While inflating the cuff the patient had chest pain and dizziness, which disappeared as soon as deflating the cuff. He recovered promptly. Nonetheless, he was re-admitted to hospital for more investigations, including a coronary angiogram. With great surprise, the left internal mammary artery had an anomalous origin and course. It arose from the deep brachial artery.