Arteriovenous fistula of internal mammary artery after median sternotomy.

A female patient who had undergone median sternotomy for coronary artery bypass was found to have a continuous murmur on examination one month postoperatively. An arteriovenous fistula involving the right internal mammary artery, thymic, and second intercostal veins was diagnosed with selective angiography. An attempt at embolization of the fistula failed. Therefore, ligation and excision of the fistula was carried out. The etiology was attributed to parasternal wire placement during closure of the median sternotomy.