Retrocaval routing of the right internal thoracic artery
1Division of Cardiothoracic Surgery, San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.
The Annals of Thoracic Surgery
|July 1, 1993
Insights
The right internal thoracic artery can be enhanced for myocardial revascularization. Advanced dissection techniques allow for longer arterial grafts to posterior and lateral coronary arteries.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for myocardial revascularization.
- Arterial conduits are preferred for CABG due to their long-term patency rates.
- The right internal thoracic artery (RITA) is increasingly utilized as an arterial conduit.
Purpose of the Study:
- To describe an enhanced technique for utilizing the right internal thoracic artery (RITA) in myocardial revascularization.
- To highlight methods for increasing RITA pedicle length for improved graftability.
- To demonstrate the feasibility of RITA grafting to posterior and lateral coronary arteries.
Main Methods:
- Detailed description of high proximal dissection of the RITA.
- Explanation of RITA routing posterior to the superior vena cava.
- Surgical technique focusing on pedicle length optimization for complex coronary artery targets.
Main Results:
- The described technique successfully increased RITA pedicle length.
- Facilitated grafting of posterior and lateral coronary arteries was achieved.
- A less circuitous and more protected arterial grafting route was established.
Conclusions:
- Enhanced utilization of the RITA, via specific dissection and routing, expands arterial grafting options for myocardial revascularization.
- This technique allows for more extensive revascularization with arterial conduits, potentially improving long-term outcomes.
- The RITA can be effectively employed for challenging coronary targets, including posterior and lateral vessels.
Abstract:
Enhanced use of the right internal thoracic artery affords further opportunity for myocardial revascularization using predominantly arterial conduits. High proximal dissection and routing of the right internal thoracic artery behind the superior vena cava can sometimes allow additional length to the right internal thoracic artery pedicle to facilitate the grafting of posterior and lateral coronary arteries via a less circuitous, more protected route.
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