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Internal thoracic artery: to skeletonize or not to skeletonize?

Shahzad G Raja1, Gilles D Dreyfus

  • 1Department of Cardiac Surgery, Alder Hey Hospital, Liverpool, United Kingdom. drrajashahzad@hotmail.com

The Annals of Thoracic Surgery
|April 28, 2005
PubMed

Insights

Skeletonization of the internal thoracic artery (ITA) provides longer grafts for coronary artery bypass grafting, potentially improving outcomes. Further randomized trials are needed to confirm its long-term safety and efficacy compared to traditional methods.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Grafting

Background:

  • The internal thoracic artery (ITA) is a preferred graft in coronary artery bypass grafting (CABG) due to its superior long-term patency.
  • Achieving adequate graft length is crucial for complete myocardial revascularization.
  • The skeletonization technique aims to increase ITA graft length.

Purpose of the Study:

  • To evaluate the safety and efficacy of the skeletonization technique for harvesting the internal thoracic artery (ITA) in coronary artery bypass grafting (CABG).
  • To assess the potential benefits of skeletonized ITA grafts, including increased length and reduced complications.
  • To identify the need for further research comparing skeletonized and pedicled ITA grafts.

Main Methods:

  • Review of existing retrospective studies (level 3 evidence) on the skeletonization technique for ITA harvesting.
  • Comparison of skeletonized ITA grafts with traditional pedicled grafts in CABG.
  • Analysis of graft patency, surgical complications, and long-term patient outcomes.

Main Results:

  • Skeletonization allows for longer ITA conduits, potentially improving free flow and reducing sternal/pulmonary complications.
  • Concerns regarding vasoreactivity, surgical trauma, and vasa vasorum perfusion persist.
  • Current evidence suggests skeletonization is safe and effective for myocardial revascularization.

Conclusions:

  • Skeletonization of the ITA is a promising technique for enhancing graft length in CABG.
  • Further multicenter, randomized controlled trials are essential to definitively establish the long-term patency and efficacy of skeletonized ITA grafts.
  • High-quality evidence is needed to universally accept the skeletonization technique over the pedicled approach.

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