Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafting

Abstract

Background-Skeletonized harvesting of the internal thoracic artery (ITA) decreases the severity of sternal devascularization, thus reducing the risk of postoperative sternal complications in patients undergoing bilateral ITA grafting. Methods and Results-Between

Coronary Artery Disease and Diabetes Mellitus

“…95 However, the use of BITA results in greater sternal wound complications in patients with DM (especially insulin-treated). 96,97 Harvesting skeletonized ITA may reduce the risk of sternal wound complications associated with BITA by minimizing the risk of devascularization of the sternum as compared with removal with an attached muscle pedicle. 95,98 Therefore, some surgeons believe that DM is not a contraindication for skeletonized BITA.…”

Conduit Selection for Improved Outcomes in Coronary Artery Bypass Surgery

“…Nevertheless, selection of patients for BIMA grafting should be performed cautiously, particularly when performing surgery through a standard median sternotomy incision. This is primarily related to the well-demonstrated risk for sternal wound infection after BIMA grafting in patients with diabetes, obesity, and other comorbidities [96][97][98][99][100]. However, BIMA grafting can be performed safely without significant increased risk for sternal wound infection as has been frequently demonstrated [24,98,100,101].…”

“…This is primarily related to the well-demonstrated risk for sternal wound infection after BIMA grafting in patients with diabetes, obesity, and other comorbidities [96][97][98][99][100]. However, BIMA grafting can be performed safely without significant increased risk for sternal wound infection as has been frequently demonstrated [24,98,100,101]. For example, Jones et al reviewed their experience with 500 consecutive patients undergoing BIMA CABG over an 11-year period, excluding only those with proximal coronary stenoses <70% and emergency cases with HD instability.…”

“…As a result, skeletonized IMA harvesting is associated with reduced sternal wound complications and longer IMA graft length, allowing more distal coronary targets to be bypassed [Figure,92,98,100]. Skeletonized IMAs also have increased blood flow through the conduit [114], possible as the result of decreased spasm, since skeletonized IMA is typically accomplished without the need for electrocautery on the chest wall [100,106,115].…”

Dissecção da artéria torácica interna de modo esqueletizado

“…There is already enough information in the medical literature to conclude that the withdrawal of ITA using the skeletonized technique is not accompanied by a greater injury of ITA and lower graft patency [6].…”