Document Detail


Pedicled or skeletonized? A review of the internal thoracic artery graft.
MedLine Citation:
PMID:  12959197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The internal thoracic artery is the gold-standard conduit for coronary artery bypass surgery. Until recently, it was used almost exclusively as a pedicle, with construction of 1 distal anastomosis. Skeletonization of the internal thoracic artery has recently been advocated in order to increase the number of arterial anastomoses and decrease the occurrence of sternal wound infections. When skeletonized, the vessel loses its "milieu" which raises the question of whether this technique sacrifices the superior longevity of the conduit. The current status of research on the effects of skeletonization (depriving the internal thoracic artery of vasa vasorum, innervation, and lymphatic and venous drainage, together with creating an imbalance between vasoconstricting and vasodilating substances) appears to support the superiority of the pedicled graft. Long-term patency studies of the skeletonized ITA, with meticulous follow-up and confirmation by angiography, are not currently available. Theoretically, skeletonization of the ITA might adversely affect its long-term resistance to atherosclerosis. More data are needed before this technique can be universally recommended. If the skeletonized ITA has decreased long-term patency, bypass surgery may be at a disadvantage when compared with the new generation of drug-eluting stents.
Authors:
Carlos Del Campo
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  30     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2003  
Date Detail:
Created Date:  2003-09-08     Completed Date:  2004-01-13     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-5     Citation Subset:  IM    
Affiliation:
The Department of Cardiovascular and Thoracic Surgery, Western Medical Center, Anaheim, California 92805, USA. cdelcampo@pol.net
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass / methods*
Coronary Artery Disease / surgery*
Humans
Mammary Arteries / physiopathology,  transplantation*
Vascular Patency / physiology
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