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Ann Thorac Surg 2005;79:1805-1811
© 2005 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, Alder Hey Hospital, Liverpool, United Kingdom
b Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
Accepted for publication May 18, 2004.
* Address reprint requests to Dr Raja, Department of Cardiac Surgery, Alder Hey Hospital, Eaton Rd, Liverpool, L12 2AP UK (E-mail: drrajashahzad{at}hotmail.com).
The internal thoracic artery has been the most reliable graft material used in coronary artery bypass grafting with an excellent long-term patency rate. Complete myocardial revascularization with internal thoracic arteries improves long-term survival and decreases the rate of repeat operations compared with vein grafts. Adequate length of the graft in coronary artery bypass graft surgery is essential for providing complete arterial revascularization. In the last decade or so, technique of skeletonization of internal thoracic artery has been proposed to achieve extra length. Skeletonization of the internal thoracic artery allows the preparation of longer conduits with a superior free flow and can reduce the incidence of postoperative pulmonary and sternal complications. However, concerns about vasoreactivity of skeletonized internal thoracic artery grafts, the functional consequences of surgical trauma, the possible loss of innervation, and vasa vasorum perfusion in the skeletonized conduits have prevented this technique from being universally accepted. Presently available evidence from retrospective studies (level 3 evidence) suggests that skeletonization is a safe and effective technique for myocardial revascularization. However, there is a need for conducting multicenter, randomized controlled trials comparing the skeletonized and pedicled internal thoracic arteries with special emphasis on long-term patency to conclusively validate the safety and efficacy of skeletonization technique.
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