[Coronary Artery Bypass Grafting Using a Left Internal Thoracic Artery Harvested by the "Bony Pedicled Method"]

A detailed report how to dissect an internal thoracic artery (ITA) from severe adhesion of thoracic bone tissue is not seen. We herein report the "bony pedicled method" as a novel technique for harvesting ITA graft in difficult case, such as severe adhesion to the costosternal portion. Case 1 was a 70-yearold man who had three-vessel-disease (3VD). Case 2 was a 69-year-old man who had unstable angina pectoris( UAP) due to severe 3VD. Case 3 was a 68-year-old man who had UAP due to left main trunk and double-vessel-disease. We planned coronary artery bypass grafting (CABG) using a left internal thoracic artery( LITA) grafts in these 3 cases. In their operative findings, LITAs had severe adhesion to the costosternal portions, so we dissected these portions using the "bony pedicled method" to avoid injury to the LITA grafts. We harvested the LITA grafts without any complications and performed their CABG as preoperative planning. Their postoperative courses were uneventful. All bypasses, including the LITA-left anterior descending artery( LAD) bypass in the 3 cases were patent on postop912 Vol.78 No.11(2025-10) erative three dimensional computed tomography( 3D-CT). The "bony pedicled method" is an appropriate method for harvesting ITA graft without injury in case which graft harvesting is difficult due to adhesion to the costosternal portion.