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This Article 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 Google Scholar Google Scholar Articles by Cunningham, J. M. Search for Related Content PubMed PubMed Citation Articles by Cunningham, J. M.

J Thorac Cardiovasc Surg 1996;111:489-490
© 1996 Mosby, Inc.

Letters to the Editor

Skeletonization of internal thoracic artery grafts

Columbus, GA 31904

To the Editor:

I would like to comment on two articles appearing in the August 1995 issue of the JOURNAL. I read with interest the article by Kushwaha and associates ¹ regarding the late function of free and pedicled internal thoracic artery (ITA) grafts. In this report, the authors state, "Skeletonization [of the ITA] may provide greater length but still usually does not permit grafting of the left anterior descending coronary artery or its branches." As the primary author of one of their references regarding the technique of skeletonization, ² I would like to politely disagree. In fact, one of the advantages of skeletonization is the ability to use the right ITA to bypass the left anterior descending coronary when the left ITA is anastomosed to a circumflex coronary branch. In my experience, inability to reach the left anterior descending coronary artery with a skeletonized right ITA is a rare exception rather than the rule. I do agree with the authors that free ITA grafts are excellent conduits and should be used if there is any question regarding adequate length.

My second comment is in regard to the use of the electrocautery in the skeletonization technique of ITA dissection. In their article comparing the effects of monopolar and bipolar cauterization on skeletonized ITA's, Yoshida and associates ³ go into detail describing the damaging effects of the two cauterization techniques on these relatively fragile arteries. I suggest that the arteries would sustain far less damage and hemostasis would be immediate and secure if hemoclips, rather than cautery, are used on the ITA branches. As described in our article, ² thermal trauma to the ITA is thus specifically avoided. If meticulous clip application techniques are used and scrupulous attention is paid to the details of the dissection, fewer than 1% of skeletonized ITAs are unsuitable conduits.

One of the main advantages to the use of arterial conduits is their longevity. I therefore propose that conduit life will remain optimum if we do our best to use harvesting techniques that keep arterial wall and intimal trauma to an absolute minimum.

References

1. Kushwaha SS, Bustami M, Tadjkarimi S, Ilsey CD, Mitchell AG, Yacoub MH. Late endothelial function of free and pedicled internal mammary artery grafts. J Thorac Cardiovasc Surg 1995;110:453-62.[Abstract/Free Full Text]
   
2. Cunningham JM, Gharavi MA, Fardin R, Meek RA. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg 1992;54:947-51.[Abstract/Free Full Text]
   
3. Acedia H, Wu MH, Kouchi Y, Onuki Y, Shi Q, Sauvage LR. Comparison of the effect of monopolar and bipolar cauterization on skeletonized, dissected internal thoracic arteries. J Thorac Cardiovasc Surg 1995;110:504-10.[Abstract/Free Full Text]
   

This Article 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 Google Scholar Google Scholar Articles by Cunningham, J. M. Search for Related Content PubMed PubMed Citation Articles by Cunningham, J. M.