Proposal of a new method for the skeletonized internal mammary artery harvesting: Historical, anatomical and physiological fundaments
Abstract
In the last 30 years the interest of the cardiovascular surgeons for the skeletonized dissection of the internal mammary artery has increased, mainly stimulated by its bilateral use, to achieve the total arterial revascularization in the greater amount of patients; this, in theory, is accompanied by a higher incidence of deep infections of the sternal wound. Since 1992, the classical technique of the mammary skeletonized dissection has practically not changed. Perhaps, the only major changes have been the introduction of the harmonic cauterizer around the year 2000 and the tendency of a few groups to try to preserve intact the retrosternal venous plexus. After a thorough analysis of the historical, anatomical and physiological fundaments on which this procedure is based, and based on the practice in more than 100 patients over a period of two years, modifications are presented for the classical technique of the skeletonized dissection of the internal mammary artery that allow obtaining a healthier hemoduct in less time, greater protection against infection and ischemia of the bone and mediastinal organs, as well as the preservation of the integrity of the internal mammary vein.
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1. Vineberg A, Miller G. Internal mammary coronary anastomosis in the surgical treatment of coronary artery insufficiency. Can Med Assoc J. 1951;64(3):204-10.
2. Sewell WH. Results of 122 mammary pedicle implantations for angina pectoris. Ann Thorac Surg. 1966;2(1):17-30.
3. Cunningham JM, Gharavi MA, Fardin R, Meek RA. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg. 1992;54(5):947-50.
4. Gurevitch J, Kramer A, Locker C, Shapira I, Paz Y, Matsa M, et al. Technical aspects of double-skeletonized internal mammary artery grafting. Ann Thorac Surg. 2000;69(3):841-6.
5. He GW, Taggart DP. Spasm in arterial grafts in coronary artery bypass grafting surgery. Ann Thorac Surg. 2016;101(3):1222-9.
6. Keeley SB. The skeletonized internal mammary artery. Ann Thorac Surg. 1987;44(3):324-5.
7. Satdhabudha O, Noppawinyoowong N. A randomized comparison of flow characteristics of semiskeletonized and pedicled internal thoracic artery preparations in coronary artery bypass. J Cardiothorac Surg [Internet]. 2017 [citado 26 May 2018];12(1):28. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434624/pdf/13019_2017_Article_589.pdf
8. Ji Q, Xia L, Shi Y, Ma R, Shen J, Lai H, et al. In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery: Feasibility, Mid-Term Efficacy, and Risk Factors for Graft Failure. Int Heart J. 2018;59(1):35-42.
9. Gatti G, Dell’Angela L, Maschietto L, Luzzati R, Sinagra G, Pappalardo A. The impact of diabetes on early outcomes after routine bilateral internal thoracic artery grafting. Heart Lung Circ. 2016;25(8):862-9.
10. Robinson BM, Paterson HS, Naidoo R, Dhurandhar V, Denniss AR. Bilateral internal thoracic artery composite Y grafts: Analysis of 464 angiograms in 296 patients. Ann Thorac Surg. 2016;101(3):974-80.
11. Luzurier Q, Le Guillou V, Lottin M, Vermeulin T, Marini H, Petel T, et al. Is the risk of wound infection related to bilateral internal thoracic artery graft potentiated by age? Ann Thorac Surg. 2016;102(4):1239-44.
12. Sahar G, Shavit R, Yosibash Z, Novack L, Matsa M, Medalion B, et al. The physiologic and histologic properties of the distal internal thoracic artery and its subdivisions. J Thorac Cardiovasc Surg. 2015;149(4):1042-50.
13. Harky A, Mohammad HA, Garner M, Ali M, Alani MS. Anomalous right internal thoracic artery terminating in the right superior pulmonary vein. Ann Thorac Surg. 2017;104(4):e323-4.
14. Sajja LR, Mannam G. Internal thoracic artery: Anatomical and biological characteristics revisited. Asian Cardiovasc Thorac Ann. 2015;23(1):88-99.
15. Onan B, Yeniterzi M, Onan IS, Ersoy B, Gonca S, Gelenli E, et al. Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy. Tex Heart Inst J. 2014;41(5):484-90.
16. Martínez Comendador JM, Castaño M, Álvarez JR. Biología y resultados de la arteria mamaria interna. Cir Cardiov. 2011;18(4):269-75.
17. Honda K, Okamura Y, Nishimura Y, Uchita S, Yuzaki M, Kaneko M, et al. Graft flow assessment using a transit time flow meter in fractional flow reserve-guided coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2015;149(6):1622-8.
18. Hwang HY, Koo BK, Yeom SY, Kim TK, Kim KB. Endothelial shear stress of the saphenous vein composite graft based on the internal thoracic artery. Ann Thorac Surg. 2018;105(2):564-71.
19. Saha KK. Graft spasm – The Achilles heel of arterial grafts. Indian Heart J. 2017;69(5):571-2.
20. Kociszewska K, Malinowski M, Czekaj P, Deja MA. What is the source of anticontractile factor released by the pedicle of human internal thoracic artery? Interact Cardiovasc Thorac Surg. 2015;21(3):301-7.
21. Manenti A, Roncati L. Nervous network of skeletonized internal thoracic artery. Ann Thorac Surg. 2013;95(4):1511-2.
22. Picichè M. Noncoronary collateral myocardial blood flow: The human heart’s forgotten blood supply. Open Cardiovasc Med J. 2015;9:105-13.
23. Al-Atassi T, Toeg HD, Chan V, Ruel M. Coronary Artery Bypass Grafting In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston & Spencer: Surgery of the chest. 9ª ed. Philadelphia: Elsevier; 2016. p. 1551-88.
24. Ahmed S, Raman SP, Fishman EK. CT angiography and 3D imaging in aortoiliac occlusive disease: Collateral pathways in Leriche syndrome. Abdom Radiol (NY). 2017;42(9):2346-57.
25. Hutchison SJ. Coarctation and Atresia of the Aorta. In: Hutchison SJ, Eagle KA, Diethrich EB, Peterson MD. Aortic Diseases Clinical Diagnostic Imaging Atlas. Philadelphia: Elsevier; 2009. p. 271-96.
26. Andreas M, Zeitlinger M, Hoeferl M, Jaeger W, Zimpfer D, Hiesmayr JM, et al. Internal mammary artery harvesting influences antibiotic penetration into presternal tissue. Ann Thorac Surg. 2013;95(4):1323-9.
27. Pasrija C, Ghoreishi M, Shah A, Rouse M, Gammie JS, Kon ZN, et al. Bilateral internal mammary artery use can be safely taught without increasing morbidity or mortality. Ann Thorac Surg. 2018;105(1):76-82.
28. Nakahara Y, Yoshida S, Kanemura T, Yamagishi S, Tochigi S, Osaka S. Bilateral internal thoracic artery grafts in hemodialysis: A single-center propensity score analysis. Ann Thorac Surg. 2018;105(1):153-9.
29. Hudson CL, Moritz AR, Wearn JT. The extracardiac anastomoses of the coronary arteries. J Exp Med. 1932;56(6):919-25.
30. Stoller M, Seiler C. Effect of permanent right internal mammary artery closure on coronary collateral function and myocardial ischemia. Circ Cardiovasc Interv [Internet]. 2017 [citado 20 Feb 2018];10(6):e004990. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/CIRCINTERVENTIONS.116.004990
31. Sever AJ, Patel C, Albeer Y, Darian VB. The technique and benefits of angiographic embolization of inferior epigastric arteries prior to pedicled TRAM flap breast reconstruction: Results from a single center. Cardiovasc Intervent Radiol. 2017;40(12):1845-50.
32. Nezic DG, Bojovic ZR, Milicic MD, Antonic ZD, Boricic MI, Micovic SV. Mid-term patency of the inverted left internal thoracic artery conduit. J Card Surg. 2014;29(6):790-3.
33. Schwabegger AH. Deformities of the anterior thoracic wall. In: Congenital Thoracic Wall Deformities Diagnosis, Therapy and Current Developments. New York: Springer-Verlag; 2011. p. 3-56.
34. Cheng K, Rehman SM, Taggart DP. A review of differing techniques of mammary artery harvesting on sternal perfusion: Time for a randomized study? Ann Thorac Surg. 2015;100(5):1942-53.
35. Ding WJ, Ji Q, Shi YQ, Ma RH, Wang CS. Incidence of deep sternal wound infection in diabetic patients undergoing off-pump skeletonized internal thoracic artery grafting. Cardiology. 2016;133(2):111-8.
36. Papaspyros S, Zamvar V. Operative Techniques: Coronary Artery Bypass Graft Surgery. In: Lanzer P, ed. PanVascular Medicine. Berlin: Springer-Verlag; 2015. p. 2351-8.
37. Vineberg AM, Becerra A, Chari RS. The influence of the Vineberg sponge operation upon the hydrostatics of the myocardial circulation in health and disease: Evidence of luminal ventricular circulation in the beating heart. Can Med Assoc J. 1961;85(20):1075-90.
38. Parissis H, Chughtai Z, Soo A. Two questions on bilateral internal mammary artery usage. Asian Cardiovasc Thorac Ann. 2013;21(6):751-5.
39. Schipper RJ, Lobbes MB, Dikmans RE, Beets-Tan RG, Smidt ML, Boetes C. Bilateral analysis of the cross-sectional area of the internal mammary arteries and veins in patients with and without breast cancer on breast magnetic resonance imaging. Insights Imaging. 2013;4(2):177-84.
40. Punjabi PP, Chan KMJ. Coronary artery bypass grafting. In: Punjabi PP, ed. Essentials of Operative Cardiac Surgery. Switzerland: Springer International Publishing; 2015. p. 67-79.
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