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Angiographic anatomy of the grafted left internal mammary artery
A M Calafiore1, M Contini, A L Iacò
1Department of Cardiology and Cardiac Surgery, University G. D'Annunzio of Chieti, Italy. calafiore@unich.it
Insights
Undivided branches of the left internal mammary artery (LIMA) are common after myocardial revascularization. New LIMA branches develop over time, regardless of surgical approach, indicating successful coronary artery grafting.
Area of Science:
- Cardiovascular Surgery
- Anatomical Studies
- Interventional Cardiology
Background:
- Investigating the commonality of persistent, undivided branches of the left internal mammary artery (LIMA) post-myocardial revascularization.
- Examining the anatomical variations and development of LIMA branches after surgical procedures.
Purpose of the Study:
- To determine if undivided branches of the LIMA are a frequent occurrence following myocardial revascularization.
- To compare the persistence of LIMA branches based on surgical harvesting techniques (left anterior small thoracotomy vs. median sternotomy).
Main Methods:
- Analysis of 300 postoperative angiographies of the left internal mammary artery (LIMA) after myocardial revascularization.
- Categorization of LIMA harvesting into left anterior small thoracotomy (n=150) and median sternotomy (n=150) groups.
- Recording the presence and characteristics of LIMA branches, including common origins and lateral costal branches.
Main Results:
- Persistence of lateral costal branches and common origin with subclavian artery branches were equally distributed between harvesting groups.
- Branches of 1 mm or more were significantly more frequent in the left anterior small thoracotomy group (34 vs. 4, p < 0.001).
- A notable difference in the absence of LIMA branches was observed (2 vs. 48, p < 0.001), with significantly more branches present in the left anterior small thoracotomy group.
Conclusions:
- Common origin and persistence of lateral costal branches are typical in grafted LIMA anatomy.
- New LIMA branches, some exceeding 1 mm, can develop post-surgery, irrespective of the harvesting method.
- Findings suggest that flow competition is not a limiting factor for the success of LIMA in coronary artery grafting.
Background:
The hypothesis that persistence of undivided branches is a common finding after myocardial revascularization using the left internal mammary artery was explored.
Methods:
Three hundred seven consecutive postoperative angiographies of the left internal mammary artery were considered. Seven were excluded because of occlusion or malfunction of the conduit or the anastomosis. Of the remaining 300, 150 were harvested through a left anterior small thoracotomy (group A) and 150 through a median sternotomy (group B). The persistence of undivided branches was recorded for each group.
Results:
Common origin with other branches of the subclavian artery was present in 55 patients in group A and 54 in group B (p = not significant); the persistence of lateral costal branch was also equally distributed in both groups (15 and 17; p = not significant). The first intercostal artery was present in 5 patients in group A and in none in group B (p = not significant). Branches of 1 mm or more were more frequent in group A (34 versus 4, p < 0.001), as well as branches of less than 1 mm (140 versus 67; p < 0.001). Only 2 patients in group A had no branches versus 48 patients in group B (p < 0.001).
Conclusions:
Common origin with other branches of the subclavian artery and persistence of the lateral costal branch are common aspects in the angiographic anatomy of the grafted left internal mammary artery. Moreover, new branches, sometimes wider than 1 mm, develop with time. These findings are independent from the harvesting technique, the left anterior small thoracotomy, or the median sternotomy. If flow competition between the coronary and noncoronary territories was a reality, coronary artery grafting with the left internal mammary artery would be unsuccessful since the beginning.