Use of internal thoracic artery for coronary artery grafting

Because of excellent long-term patency (greater than 90% at 7 years), internal thoracic artery (ITA) bypass grafts are preferred over saphenous vein grafts for myocardial revascularization. ITA grafts can be used for up to 70% of all distal anastomoses and in up to 95% of patients. ITA grafts are more technically demanding; inadequate length, traumatic arterial injury, torsion, separation of intima and adventitia, and anastomotic stricture are important pitfalls. Postoperative problems of bleeding, phrenic nerve injury, mediastinal infection, and arm paresis or paresthesia are complications attributed to ITA grafts, but they are uncommon if meticulous technique is used.