Internal Mammary Artery Skeletonization - Review Of Current Evidence

Authors

  • Nuno Carvalho Guerrra Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Tiago Velho Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • André Sena Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Ângelo Nobre Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal

DOI:

https://doi.org/10.48729/pjctvs.337

Abstract

Internal mammary artery (IMA) harvesting is a central part in coronary artery bypass grafting (CABG). The technique of harvesting the IMA - pedicled, skeletonized, or semi-skeletonized, may influence intra-operatory and postoperatory outcomes. We aim to review current evidence regarding the advantages and disadvantages of these techniques, and their performance in certain subsets of patients.

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References

Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018 Mar;10(3):1960-1967. doi: 10.21037/jtd.2018.02.43

Keeley SB. The skeletonized internal mammary artery. Ann Thorac Surg. 1987 Sep;44(3):324-5. doi: 10.1016/s0003- 4975(10)62088-7. PMID: 3632122.

Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beck- ie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e4-e17. doi: 10.1161/ CIR.0000000000001039. Epub 2021 Dec 9.

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ ehy394.

Horii T, Suma H. Semiskeletonization of internal thoracic artery: alternative harvest technique. Ann Thorac Surg. 1997 Mar;63(3):867-8. doi: 10.1016/s0003-4975(96)01123-x. PMID: 9066429.

Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, Sellke FW, Rubens FD. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison. Circulation. 2006 Aug 22;114(8):766-73. doi: 10.1161/ CIRCULATIONAHA.106.615427. Epub 2006 Aug 14. PMID: 16908767.

Sofer D, Gurevitch J, Shapira I, Paz Y, Matsa M, Kramer A, Mohr R. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Ann Surg. 1999 Apr;229(4):585-90. doi: 10.1097/00000658-199904000-00020.

Del Campo C. Pedicled or skeletonized? A review of the internal thoracic artery graft. Tex Heart Inst J. 2003;30(3):170- 5.

Matsa M, Paz Y, Gurevitch J, Shapira I, Kramer A, Pevny D, Mohr R. Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2001 Apr;121(4):668-74. doi: 10.1067/mtc.2001.112824.

Di Mauro M, Iacò AL, Allam A, Awadi MO, Osman AA, Cle- mente D et al. Bilateral internal mammary artery grafting:in situ versus Y-graft. Similar 20-year outcome. Eur J Cardiothorac Surg 2016;50:729. doi:10.1093/ejcts/ezw10073434.

Gopal PSS, Anne SP, Kummari ML, et al. Comparison of the effect of skeletonized and pedicled left internal thoracic artery harvesting techniques in coronary artery bypass surgery. J Evid Based Med Health 2020;7(48), 2841-2846. doi: 10.18410/jebmh/2020/582

Sazzad, M. F., Moniruzzaman, M., Chanda, P. K., Ahmed, M. N. U., Rasheed, H., Gomez, N. C., Ali, M. S., Choudhury, S. R., Malik, F. T. N., & Ahmed, F. (2018). Short Term Clinical and Angiographic Outcome of Skeletonized Harvesting Technique of Left Internal Mammary Artery, Compared to Pedicled Harvesting for Coronary Revascularization. Univer- sity Heart Journal, 12(2), 82–87. https://doi.org/10.3329/uhj.v12i2.36388

Calafiore AM, Vitolla G, Iaco AL, Fino C, Di Giammarco G, Marchesani F, Teodori G, D'Addario G, Mazzei V. Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits. Ann Thorac Surg. 1999 Jun;67(6):1637-42. doi: 10.1016/s0003-4975(99)00282-9

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. 2017 May 16;12(1):28. doi: 10.1186/s13019-017-0589-1.

Hu X, Zhao Q. Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts. Ann Thorac Surg. 2011 Jul;92(1):48-58. doi: 10.1016/j.athoracsur.2011.03.067

Sá M, Cavalcanti P, Santos H, Soares A, Miranda R, Araújo M et al. Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression. Eur J Cardiothorac Surg 2015;48:25–31.

Wendler O, Tscholl D, Huang Q, Schäfers HJ. Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in coronary artery bypass grafts. Eur J Cardiothorac Surg. 1999 Mar;15(3):247-50. doi: 10.1016/s1010- 7940(99)00012-3. PMID: 10333017.

Dreifaldt M, Samano N, Geijer H, Lidén M, Bodin L, Souza D. Pedicled versus skeletonized internal thoracic artery grafts: a randomized trial. Asian Cardiovasc Thorac Ann. 2021

Jul;29(6):490-497. doi: 10.1177/0218492320983491.

Cohen AJ, Lockman J, Lorberboym M, 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-

Lorberboym M, Medalion B, Bder O, Lockman J, Cohen N, Schachner A, Cohen AJ. 99mTc-MDP bone SPECT for the evaluation of sternal ischaemia following internal mammary artery dissection. Nucl Med Commun. 2002 Jan;23(1):47- 52. doi: 10.1097/00006231-200201000-00008. PMID: 11748437.

Dos Santos Filho EC, Moraes Neto FR, Silva RA, Moraes CR. Should the diabetics have the internal thoracic artery skeletonized? Assessment of sternal perfusion by scintillography. Rev Bras Cir Cardiovasc. 2009 Apr-Jun;24(2):157-64. doi: 10.1590/s0102-76382009000200011.

Korbmacher B, Schmitt HH, Bauer G, Hoffmann M, Vosberg H, Simic O, Gams E. Change of sternal perfusion following preparation of the internal thoracic arterya scintigraphical study. Eur J Cardiothorac Surg. 2000 Jan;17(1):58-62. doi: 10.1016/s1010-7940(99)00366-8. PMID: 10735413.

Kamiya H, Akhyari P, Martens A, Karck M, Haverich A, Lichtenberg A. Sternal microcirculation after skeletonized versus pedicled harvesting of the internal thoracic artery: a randomized study. J Thorac Cardiovasc Surg. 2008 Jan;135(1):32-7. doi: 10.1016/j.jtcvs.2007.09.004. PMID: 18179915.

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;100:1942–53.

De Paulis R, de Notaris S, Scaffa R, Nardella S, Zeitani J, Del Giudice C, De Peppo AP, Tomai F, Chiariello L. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization. J Thorac Cardiovasc Surg. 2005 Mar;129(3):536-43. doi: 10.1016/j.jtcvs.2004.07.059.

Benedetto U, Altman DG, Gerry S, Gray A, Lees B, Pawlaczyk R, Flather M, Taggart DP; Arterial Revascularization Trial investigators. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg. 2016 Jul;152(1):270- 6. doi: 10.1016/j.jtcvs.2016.03.056

Sakic A, Chevtchik O, Kilo J, Schistek R, Mueller LC, Ulmer H, Grimm M, Ruttmann E. Simple adaptations of surgical technique to critically reduce the risk of postoperative sternal complications in patients receiving bilateral internal thoracic arteries. Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):378-82. doi: 10.1093/icvts/ivt089.

Schwann TA, Gaudino MFL, Engelman DT, Sedrakyan A, Li D, Tranbaugh RF, Habib RH. Effect of Skeletonization of Bilateral Internal Thoracic Arteries on Deep Sternal Wound Infections. Ann Thorac Surg. 2021 Feb;111(2):600-606. doi: 10.1016/j.athoracsur.2020.05.044

Rubens FD, Chen L, Bourke M. Assessment of the Association of Bilateral Internal Thoracic Artery Skeletonization and Sternal Wound Infection After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2016 May;101(5):1677-82. doi: 10.1016/j.athoracsur.2015.10.031

Iddawela S, Mellor S, Zahra SA, Khare Y, Harky A. Pedicled or skeletonized bilateral internal mammary artery harvesting - a meta-analysis and trial sequential analysis, Expert Review of Cardiovascular Therapy, 19:7, 647-654, DOI: 10.1080/14779072.2021.1939684

Gaudino M, Toesca A, Nori SL, Glieca F, Possati G. Effect of skeletonization of the internal thoracic artery on vessel wall integrity. Ann Thorac Surg. 1999 Nov;68(5):1623-7. doi: 10.1016/s0003-4975(99)00664-5.

Markwirth T, Hennen B, Scheller B, Schäfers HJ, Wendler O. Flow wire measurements after complete arterial coronary revascularization with T-grafts. Ann Thorac Surg. 2001 Mar;71(3):788-93. doi: 10.1016/s0003-4975(00)01808-7

Sá MP, Ferraz PE, Escobar RR, Nunes EO, Lustosa P, Vasconcelos FP, Lima RC. Patency of skeletonized versus pedicled internal thoracic artery in coronary bypass graft surgery: a systematic review, meta-analysis and meta-regression. Int J Surg. 2014;12(7):666-72. doi: 10.1016/j.ijsu.2014.05.071

Lamy A, Browne A, Sheth T, Zheng Z, Dagenais F, Noiseux N, Chen X, Bakaeen FG, Brtko M, Stevens LM, Alboom M, Lee SF, Copland I, Salim Y, Eikelboom J; COMPASS Investigators. Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in Coronary Artery Bypass Surgery: A Post Hoc Analysis From the COMPASS Trial. JAMA Cardiol. 2021 Sep 1;6(9):1042-1049

Gaudino M, Audisio K, Rahouma M, Chadow D, Cancelli G, Soletti GJ, Gray A, Lees B, Gerry S, Benedetto U, Flather M, Taggart DP; ART Investigators. Comparison of Long-term Clinical Outcomes of Skeletonized vs Pedicled Internal Thoracic Artery Harvesting Techniques in the Arterial Revascularization Trial. JAMA Cardiol. 2021 Dec 1;6(12):1380- 1386. doi: 10.1001/jamacardio.2021.3866

Bawany FI, Khan MS, Khan A, Hussain M. Skeletonization technique in coronary artery bypass graft surgery reduces the postoperative pain intensity and disability index. J Card Surg. 2014 Jan;29(1):47-50. doi: 10.1111/jocs.12273

Bar-El Y, Gilboa B, Unger N, Pud D, Eisenberg E. Skeletonized versus pedicled internal mammary artery: impact of surgical technique on post CABG surgery pain. Eur J Cardiothorac Surg. 2005 Jun;27(6):1065-9. doi: 10.1016/j. ejcts.2005.02.016

Khan MS, Bawany FI, Khan A, Hussain M, Islam MY, Lashari MN. Comparison of the Quality of Life after Skeletonized versus Pedicled Grafts in Coronary Artery Bypass Graft Surgery. Int J Angiol. 2015 Dec;24(4):262-7. doi: 10.1055/s- 0035-1554800

Markman PL, Rowland MA, Leong JY, Van Der Merwe J, Storey E, Marasco S, Negri J, Bailey M, Rosenfeldt FL. Skeletonized internal thoracic artery harvesting reduces chest wall dysesthesia after coronary bypass surgery. J Thorac Cardiovasc Surg. 2010 Mar;139(3):674-9. doi: 10.1016/j. jtcvs.2009.03.066

Wimmer-Greinecker G, Yosseef-Hakimi M, Rinne T, Buhl R, Matheis G, Martens S, Westphal K, Moritz A. Effect of internal thoracic artery preparation on blood loss, lung function, and pain. Ann Thorac Surg. 1999 Apr;67(4):1078-82. doi: 10.1016/s0003-4975(99)00161-7

Ueda T, Taniguchi S, Kawata T, Mizuguchi K, Nakajima M, Yoshioka A. Does skeletonization compromise the integrity of internal thoracic artery grafts? Ann Thorac Surg. 2003 May;75(5):1429-33. doi: 10.1016/s0003-4975(02)04893-2

Bonini RC, Staico R, Issa M, Arnoni AS, Chaccur P, Abdulmassih Neto C, Dinkhuysen JJ, Paulista PP, Souza LC, Moreira LF. Effects of skeletonized versus pedicled radial artery on postoperative graft patency and flow. Arq Bras Cardiol. 2014 May;102(5):441-8. doi: 10.5935/abc.20140016

Massey RM, Warren OJ, Szczeklik M, Wallace S, Leff DR, Kokotsakis J, Darzi A, Athanasiou T. Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery. J Cardiothorac Surg. 2007 Jun 5;2:26. doi: 10.1186/1749-8090-2-26

Mazur P, Litwinowicz R, Tchantchaleishvili V, Natorska J, Z bczyk M, Bochenek M, Przybylski R, Iwaniec T, K dziora A, Filip G, Kapelak B. Left Internal Mammary Artery Skeletonization Reduces Bleeding-A Randomized Controlled Trial. Ann Thorac Surg. 2021 Sep;112(3):794-801. doi: 10.1016/j.athoracsur.2020.10.024

Özülkü M, Aygün F. Effect of LIMA Harvesting Technique on Postoperative Drainage in Off-Pump CABG. Braz J Car- diovasc Surg. 2016 Apr;31(2):120-6. doi: 10.5935/1678- 9741.20160024.

Matsumoto M, Konishi Y, Miwa S, Minakata K. Effect of different methods of internal thoracic artery harvest on pulmonary function. Ann Thorac Surg. 1997 Mar;63(3):653-5. doi: 10.1016/s0003-4975(96)01032-6

Peterson MD, Borger MA, Rao V, Peniston CM, Feindel CM. Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes. J Thorac Cardiovasc Surg. 2003 Nov;126(5):1314-9. doi: 10.1016/s0022-5223(03)00808-0

Kieser TM, Rose MS, Aluthman U, Narine K. Quicker yet safe: skeletonization of 1640 internal mammary arteries with harmonic technology in 965 patients. Eur J Cardiothorac Surg. 2014 May;45(5):e142-50. doi: 10.1093/ejcts/ ezu024

Saxena P, Mejia R, Tam R. Hydrodissection technique of harvesting left internal thoracic artery. Ann Thorac Surg. 2005 Jul;80(1):355-6. doi: 10.1016/j.athoracsur.2004.02.004

Bahcivan M, Kolbakir F, Karamustafa H, Keceligil HT. Endo- thoracic papaverine application for internal thoracic artery harvest. Asian Cardiovasc Thorac Ann. 2007 Jun;15(3):234-7. doi: 10.1177/021849230701500312

Saxena P, Tam R. Papaverine hydrodissection of internal thoracic artery. Asian Cardiovasc Thorac Ann. 2007 Dec;15(6):542. doi: 10.1177/021849230701500625

Maskell P, Berks M, Vibhishanan J, Harky A. In patients undergoing coronary artery bypass grafting is semi-skeletonization superior to pedicled harvesting of the leftinternal mammary artery? Interact CardioVasc Thorac Surg 2021;33:362–6.

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Published

14-01-2023

How to Cite

1.
Carvalho Guerrra N, Velho T, Sena A, Nobre Ângelo. Internal Mammary Artery Skeletonization - Review Of Current Evidence. Rev Port Cir Cardiotorac Vasc [Internet]. 2023 Jan. 14 [cited 2023 Feb. 3];29(4):43-9. Available from: https://pjctvs.com/index.php/journal/article/view/337

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