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Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery
Rachel M Massey1, Oliver J Warren, Michal Szczeklik
1Department of BioSurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Wing, St, Mary's Hospital, Praed Street, London, W2 1NY, UK. r.massey@imperial.ac.uk
Insights
Skeletonized radial and gastroepiploic arteries show potential for improved graft patency in coronary artery bypass surgery. However, insufficient high-quality evidence currently supports their routine use over traditional pedicled techniques.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Techniques
Background:
- Skeletonized harvesting of the internal thoracic artery offers advantages in coronary artery bypass graft (CABG) surgery.
- Emerging evidence suggests skeletonization can be applied to radial and gastroepiploic arteries.
Purpose of the Study:
- To systematically review evidence on skeletonized radial and gastroepiploic artery use in CABG.
- To evaluate effects on conduit length, flow, endothelial damage, graft patency, and clinical outcomes.
Main Methods:
- Systematic search of four electronic databases for human studies on skeletonization in coronary revascularization.
- Manual checking of reference lists for additional relevant publications.
Main Results:
- Some evidence suggests skeletonization may improve short- to mid-term angiographic patency compared to pedicled grafts.
- No increased complication rates or operating times were observed.
- Skeletonization may increase conduit length and sequential graft sites, but clear clinical benefits are not apparent.
Conclusions:
- Current high-quality evidence is insufficient to advocate routine skeletonized radial or gastroepiploic artery use over pedicled techniques in CABG.
- Further research is needed to establish definitive clinical advantages.
Abstract:
The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.
