Document Detail


Skeletonization of the internal thoracic artery for coronary artery bypass grafting.
MedLine Citation:
PMID:  19696665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Multiple cohort studies have shown that long-term outcomes after coronary surgery can be markedly improved when bilateral internal thoracic arteries (BITA) are used for revascularization. Applying this strategy is challenging, however, as a large proportion of patients suffer from comorbidities such as diabetes, and sternal devascularization with BITA may increase the risk of complications. Skeletonization is a technique of internal thoracic artery (ITA) harvest that has been proposed to reduce chest wall ischemia and thus minimize these problems. RECENT FINDINGS: Evidence is presented from animal and human studies which confirm that skeletonization preserves sternal blood flow. When meticulously completed, skeletonization is not associated with vessel wall damage. Intrapatient comparisons have conclusively demonstrated that skeletonization minimizes chest wall pain and discomfort. Many studies have confirmed that, when this strategy is used for BITA, the incidence of sternal wound infection approximates that seen with single ITA use, even in diabetic patients on insulin. Finally, there is no evidence in the current literature to suggest that skeletonization jeopardizes ITA patency. SUMMARY: The strategy of skeletonization is an advance that will facilitate complete arterial revascularization in high-risk patients whose surgery has previously been limited to saphenous vein conduits. Theoretical concerns challenging this approach should be tested long-term in a randomized clinical trial in patients undergoing BITA revascularization.
Authors:
Fraser D Rubens; Munir Boodhwani
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  24     ISSN:  1531-7080     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2010-01-14     Completed Date:  2010-03-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  559-66     Citation Subset:  IM    
Affiliation:
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. frubens@ottawaheart.ca
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MeSH Terms
Descriptor/Qualifier:
Animals
Coronary Artery Bypass / adverse effects*
Coronary Artery Disease / surgery*
Humans
Mammary Arteries / transplantation*
Surgical Wound Infection / prevention & control*
Tissue and Organ Harvesting
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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