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Anatomical study of the internal thoracic arteries; implications for use in coronary artery bypass graft surgery

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

Purpose

The feasibility of coronary artery bypass grafting using an internal thoracic artery (ITA) depends on the length of the graft with respect to the optimal route to reach the coronary target. The goal of this study was to assess the gain in length afforded by skeletonization and to evaluate the lengths of different pathways of the ITAs to the left coronary arteries.

Methods

The left and right ITAs were dissected out from 20 specimens and measured before and after skeletonization. Distance between the origin of the right ITA and the base of the left atrial appendage, corresponding to the proximal circumflex artery, was measured for both the transverse pericardial sinus and preaortic routes.

Results

Skeletonization gave a significant gain of length for both ITAs. Analysis showed no significant correlation between the ITA length and the height, weight, and BMI of specimens. We found no association between the length of the sternum and the length of skeletonized RITA or LITA. The anterior route of the skeletonized right ITA was shorter than the transverse pericardial sinus route in 18 cases. The average length to the circumflex artery territory was 132.8 ± 23.5 mm in front of the aorta and 150.5 ± 18.8 through the transverse pericardial sinus with a gain of length of 17.7 mm (p < 0.0001).

Conclusion

Skeletonization gave significant gains in length of both ITAs. The preaortic route for the skeletonized right ITA toward the circumflex territory was shorter than the transverse pericardial sinus route in 90 % of cases.

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References

  1. Berdajs D, Turina M (2011) Operative anatomy of the heart. Springer, Berlin, Heidelberg

    Book  Google Scholar 

  2. Blin D, Chavanon O (1999) Exposure for harvesting coronary bypass grafts. In: Branchereau A, Berguer R (eds) Vascular surgical approaches. Futura Publishing, New York, pp 113–122

    Google Scholar 

  3. Buxton BF, Ruengsakulrach P, Fuller J, Rosalion A, Reid CM, Tatoulis J (2000) The right internal thoracic artery graft benefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Cardiothorac Surg 18:255–261

    Article  CAS  PubMed  Google Scholar 

  4. Buxton BF, Hayward PA, Newcomb AE, Moten S, Seevanayagam S, Gordon I (2009) Choice of conduits for coronary artery bypass grafting: craft or science? Eur J Cardiothorac Surg 35:658–670

    Article  PubMed  Google Scholar 

  5. Buxton BF, Shi WY, Tatoulis J, Fuller JA, Rosalion A, Hayward PA (2014) Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival. J Thorac Cardiovasc Surg 148:1238–1243

    Article  PubMed  Google Scholar 

  6. Cameron A, Davis KB, Green G, Schaff HV (1996) Coronary bypass surgery with internal-thoracic-artery-grafts. Effects on survival over a 15-year period. N Engl J Med 334:216–219

    Article  CAS  PubMed  Google Scholar 

  7. Deja MA, Woś S, Gołba KS, Zurek P, Domaradzki W, Bachowski R et al (1999) Intraoperative and laboratory evaluation of skeletonized versus pedicled internal thoracic artery. Ann Thorac Surg 68:2164–2168

    Article  CAS  PubMed  Google Scholar 

  8. Di Mauro M, Iacò AL, Acitelli A, D’Ambrosio G, Filipponi L, Salustri E et al (2015) Bilateral internal mammary artery for multi-territory myocardial revascularization: long-term follow-up of pedicled versus skeletonized conduits. Eur J Cardiothorac Surg 47:698–702

    Article  PubMed  Google Scholar 

  9. Fouquet O, Tariel F, Desulauze P, Mével G (2015) Does a skeletonized internal thoracic artery give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg 20:663–668

    Article  PubMed  Google Scholar 

  10. He GW (1999) Arterial grafts for coronary artery bypass grafting: biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 67:277–284

    Article  CAS  PubMed  Google Scholar 

  11. Hu X, Zhao Q (2011) Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts. Ann Thorac Surg 92:48–58

    Article  PubMed  Google Scholar 

  12. Kappetein AP (2010) Bilateral mammary artery vs. single mammary artery grafting: promising early results: but will the match finish with enough players? Eur Heart J 31:2444–2446

    Article  PubMed  Google Scholar 

  13. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al (1986) Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1–6

    Article  CAS  PubMed  Google Scholar 

  14. Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM (2004) The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 78:2005–2012 (discussion 2012–4)

    Article  PubMed  Google Scholar 

  15. Pettinari M, Sergeant P, Meuris B (2015) Bilateral internal thoracic artery grafting increases long-term survival in elderly patients. Eur J Cardiothorac Surg 47:703–709

    Article  PubMed  Google Scholar 

  16. Puskas JD, Sadiq A, Vassiliades TA, Kilgo PD, Lattouf OM (2012) Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. Ann Thorac Surg 94:710–715 (discussion 715–6)

    Article  PubMed  Google Scholar 

  17. Sá MP, Cavalcanti PE, Santos HJ, Soares AF, Miranda RG, Araújo ML et al (2014) Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression. Eur J Cardiothorac Surg. doi:10.1093/ejcts/ezu344 (first published online September 15)

    PubMed  Google Scholar 

  18. Saso S, James D, Vecht JA, Kidher E, Kokotsakis J, Malinovski V et al (2010) Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection. Ann Thorac Surg 89:661–670

    Article  PubMed  Google Scholar 

  19. Shah PJ, Bui K, Blackmore S, Gordon I, Hare DL, Fuller J et al (2005) Has the in situ right internal thoracic artery been overlooked? An angiographic study of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients. Eur J Cardiothorac Surg 27:870–875

    Article  PubMed  Google Scholar 

  20. Members Task Force, Montalescot G, Sechtem U, Achenbach S et al (2013) ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013(34):2949–3003

    Google Scholar 

  21. Tatoulis J, Buxton BF, Fuller JA (2011) The right internal thoracic artery: the forgotten conduit—5,766 patients and 991 angiograms. Ann Thorac Surg. 92:9–15 (discussion 15–7)

    Article  PubMed  Google Scholar 

  22. Van Son JA, Smedts F, de Wilde PC, Pijls NH, Wong-Alcala L, Kubat K et al (1993) Histological study of the internal mammary artery with emphasis on its suitability as a coronary artery bypass graft. Ann Thorac Surg 55:106–113

    Article  PubMed  Google Scholar 

  23. Vander Salm TJ, Chowdhary S, Okike ON, Pezzella AT, Pasque MK (1989) Internal mammary artery grafts: the shortest route to the coronary arteries. Ann Thorac Surg 47:421–427

    Article  CAS  PubMed  Google Scholar 

  24. Wendler O, Tscholl D, Huang Q, Schäfers HJ (1999) Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in coronary artery bypass grafts. Eur J Cardiothorac Surg 15:247–250

    Article  CAS  PubMed  Google Scholar 

  25. Zehr KJ, Lee PC, Poston RS, Gillinov AM, Hruban RH, Cameron DE (1993) Protection of the internal mammary artery pedicle with polytetrafluoroethylene membrane. J Card Surg 8:650–655

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Philippe Masson for his contribution to the study and Alison Foote for language editing.

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Authors and Affiliations

  1. Grenoble University Hospital, Pôle Thorax et Vaisseaux, Cardiac Surgery Clinic, 38000, Grenoble, France

    Olivier Chavanon & C. Martin

  2. Univ. Grenoble Alpes, HP2 Laboratory, 38000, Grenoble, France

    Olivier Chavanon

  3. Univ. Grenoble Alpes, LADAF, Anatomical Laboratory, Grenoble University Hospital, 38000, Grenoble, France

    B. Romary & P. Chaffanjon

Authors
  1. Olivier Chavanon
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  2. B. Romary
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  3. C. Martin
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  4. P. Chaffanjon
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Correspondence to Olivier Chavanon.

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Chavanon, O., Romary, B., Martin, C. et al. Anatomical study of the internal thoracic arteries; implications for use in coronary artery bypass graft surgery. Surg Radiol Anat 38, 1135–1142 (2016). https://doi.org/10.1007/s00276-016-1678-x

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  • DOI: https://doi.org/10.1007/s00276-016-1678-x

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