Effect of internal mammary artery mobilization on sternal blood flow

Use of the internal mammary artery as a conduit for coronary artery bypass has enhanced this procedure in terms of prolonged graft patency. An earlier warning that use of both arteries would devascularize the sternum was based on postmortem radiologic imaging. This was complemented by a subsequent animal study employing isotopic microspheres. In the present clinical study, laser Doppler flowmetry was adapted to identify changes in blood supply to the left half of the divided manubrium sternum during separation of the left internal mammary artery from its chest wall attachment. Our finding of continued blood flow after this event suggests that complete devascularization of the sternum does not take place. Quality of sternal bone and surrounding tissues and clinical indications should remain as factors influencing use of one or both internal mammary arteries.