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Ann Thorac Surg 2006;81:405-406
© 2006 The Society of Thoracic Surgeons

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Correspondence

Skeletonization of the Internal Thoracic Artery: Pros and Cons

Department of Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, 777 Hemlock St, Box 27, Macon, GA 31201

(Email: cunningham.james{at}mccg.org).

To the Editor:

The article by Raja and Dreyfus [1] discussing the pros and cons of internal thoracic artery (ITA) skeletonization for conduit procurement in myocardial revascularization provides a good review of the subject. They correctly conclude that ITA dissection in a skeletonized fashion demands a very precise, atraumatic surgical technique, and harvesting time may be increased by 15 minutes or so. Also, skeletonization requires a somewhat longer learning curve than the standard pedicle technique. Although there are no reports to suggest decreased short-term or long-term patency rates for skeletonized ITAs, the authors suggest that randomized trials are needed to "conclusively validate the safety and efficacy of [the] skeletonization technique."

The authors express some concern that ITA skeletonization "is a relatively new surgical technique" but Galbut and associates [2] published their 17-year experience with 1,087 patients using bilateral skeletonized ITAs in 1990. Coronary angiography in 53 of the patients done at a mean postoperative interval of 53 months demonstrated a 92% patency rate for the left ITA and an 84% patency rate for the right ITA. One would be hard-pressed to consider a technique that has been used for over 30 years as "new." Also, in 1992, we [3] published a detailed description of all aspects of the skeletonization dissection to hopefully decrease the learning curve and prevent unnecessary technical misadventures. Our review included more than 1,000 patients with a consensus among the authors that the skeletonization technique was superior to the pedicled technique for the same reasons as detailed in the current article by Raja and Dreyfus [1].

In my opinion, the authors' extensive inquiries into the pluses and minuses of ITA skeletonization only strengthen the case for skeletonization. The literature supports the concepts of excellent flow, increased conduit length and diameter, less reduction in sternal blood flow, a decrease in sternal wound infection, less chest wall pain, and no reports of problems with an increased vasoreactive profile or with the functional integrity of the skeletonized ITA. From the data as presented, their concerns regarding long-term patency of skeletonized ITAs seem unfounded.

	References

Top References

 

1. Raja SG, Dreyfus GD. Internal thoracic arteryTo skeletonize or not to skeletonize. Ann Thorac Surg 2005;79:1805-1811.[Abstract/Free Full Text]
2. Galbut DL, Traad EA, Dorman MJ, et al. Seventeen year experience with bilateral internal mammary artery grafts Ann Thorac Surg 1990;49:195-201.[Abstract]
3. Cunningham JM, Gharavi MA, Fardin R. Considerations in the skeletonization technique of internal thoracic artery dissection Ann Thorac Surg 1992;54:947-950.[Abstract]

This article has been cited by other articles:

				S. G. Raja and G. D. Dreyfus Reply Ann. Thorac. Surg., January 1, 2006; 81(1): 406 - 406. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James M. Cunningham Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cunningham, J. M. Search for Related Content PubMed PubMed Citation Articles by Cunningham, J. M. Related Collections Coronary disease