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J Thorac Cardiovasc Surg 2001;121:1219
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Sternal vascularity after harvesting of the internal thoracic artery

Aaron Casha, MD 1, Marilyn Gauci, MD 2

1Department of Cardiothoracic Surgery
Leeds General Infirmary
Leeds LS2 9PJ, United Kingdom

2Department of Anaesthesia and Intensive Care
University of Wales College of Medicine
Cardiff CF14 4XN, United Kingdom

To the Editor:

We read with great interest the article titled, "Assessment of Sternal Vascularity With Single Photon Emission Computed Tomography After Harvesting of the Internal Thoracic Artery"Go 1 and the resulting correspondence.Go Go 2,3

Although anatomicGo 4 and angiographic studiesGo Go 5,6 show partial devascularization, studies using bone scansGo Go 3,7 paint a conflicting picture with regard to the degree of devascularization. Korbmacher and associates,Go 7 using bone scintigraphy, concluded that use of one or both internal thoracic arteries (ITAs) did not cause an increase in healing disturbances as a result of a postoperatively decreased sternal blood supply. However, a diminution in blood supply may not result in a clinical deficiency in wound healing.

Because ITA branches can originate as common trunks, potential anastomoses can occur across these joint branches (eg, sternal/intercostal) after the ITA is harvested.Go 8 Because the mean length of the common trunks is 3.0 mm, careful harvest of the common trunks close to the ITA may preserve their points of division, thereby creating a collateral blood supply after ITA mobilization.Go 9 This may be the mechanism that would account for the lack of reduction in sternal blood flow noted by Cohen and coworkersGo 1 when the ITA is skeletonized as opposed to pedicled. We believe that careful harvest of the ITA will preserve these arterial channels, so that blood flows from the intercostal arteries to the intercostal branches of the ITA and then to the points of division of the common trunks through to the sternal branches of the ITA. Thus, blood flow to the sternum occurs through these collaterals in reverse of the normal anatomic direction. Venous return is helped by preservation of the internal thoracic veins.

12/8/113928doi:10.1067/mtc.2001.113928

References

  1. Cohen AJ, Lockman J, Lorberboym M, Bder O, Cohen N, Medalion B, et al. Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery. J Thorac Cardiovasc Surg 1999;118:496-502.[Abstract/Free Full Text]
  2. Brown AH. Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery [letter]. J Thorac Cardiovasc Surg 2000;120:616.[Free Full Text]
  3. Cohen AJ. Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery [letter reply]. J Thorac Cardiovasc Surg 2000;120:616.
  4. Arnold M. The surgical anatomy of sternal blood supply. J Thorac Cardiovasc Surg 1972;64:596-610.[Medline]
  5. Seyfer AE, Shriver CD, Miller TR, Graeber GM. Sternal blood flow after median sternotomy and mobilization of the internal mammary arteries. Surgery 1988;104:899-904.[Medline]
  6. Rigaud J, Armstrong O, Robert K, Rogez JM, Le Borgne J. Anatomic bases of aorto-coronary bypasses: the internal thoracic artery and blood supply of the sternum. Surg Radiol Anat 1998;20:191-5.[Medline]
  7. Korbmacher B, Schmitt HH, Bauer G, Hoffman M, Vosberg H, Simic O, et al. Change of sternal perfusion following preparation of the internal thoracic artery—a scintigraphical study. Eur J Cardiothorac Surg 2000;17:58-62.[Abstract/Free Full Text]
  8. Schwartz DS, Petrossian E, Brodman RF, Frame R, Schwartz JD, Blitz A, et al. Wound healing after harvesting of the internal thoracic and the superior and inferior epigastric arteries. Ann Thorac Surg 1994;57:1252-5.[Abstract]
  9. Pietrasik K, Bakon L, Zdunek P, Wojda-Gradowska U, Dobosz P, Kolesnik A. Clinical anatomy of internal thoracic artery branches. Clin Anat 1999;12:307-14.[Medline]




This Article
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