This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khuri, S. F. Search for Related Content PubMed PubMed Citation Articles by Khuri, S. F. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections CV surgery: coronary artery disease

(Circulation. 2006;114:754-756.)
© 2006 American Heart Association, Inc.

Editorial

To Skeletonize the Internal Thoracic Artery or Not?

Is That the Question?

Shukri F. Khuri, MD, MS (Hon)

From the Departments of Surgery, VA Boston Healthcare System, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Mass.

Correspondence to Shukri F. Khuri, MD, VA Medical Center, 1400 VFW Parkway, West Roxbury, MA 02132. E-mail shukri.khuri@med.va.gov

Key Words: Editorials • revascularization • arteries • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The internal thoracic artery (ITA) is the preferred conduit for surgical coronary artery revascularization because of superior long-term patency rates and observational evidence of improved long-term outcomes. It is usually harvested with a pedicle of surrounding tissue, presumably not to disrupt its viability and blood supply. Resultant hypoperfusion of the sternum and an increased rate of sternal wound infections, particularly when bilateral ITAs are used, have prompted certain surgeons to harvest the ITA in a skeletonized fashion, ie, without its surrounding tissue. Stripping the ITA from its surrounding tissues interrupts its nerve and blood supply and may hypothetically interfere with its function and reactivity. However, studies that have addressed this issue, including 2 randomized studies by Gaudino and his group,^1,2 have provided convincing evidence that the integrity and reactivity of the skeletonized and pedicled ITA are similar.

Article p 766

	To Skeletonize or Not?

 
Currently, there is insufficient evidence to prompt the surgeon to harvest the ITA in a skeletonized fashion. Randomized studies comparing the skeletonized to the pedicled ITA are few, and most of the current knowledge on this subject comes from observational studies that offer insufficient evidence for or against skeletonization of the ITA.³ The report by Boodhwani et al, published in this issue of Circulation,⁴ is a welcome addition to the literature because it provides the randomized intrapatient design necessary to address, more definitively, 3 questions that are pivotal in the comparative assessment of the skeletonized and pedicled ITA grafts.

1. Does skeletonization of the ITA improve sternal hypoperfusion compared with . . . [Full Text of this Article]

This article has been cited by other articles:

				E. B. Savage, J. D. Grab, S. M. O'Brien, A. Ali, E. J. Okum, R. A. Perez-Tamayo, D. S. Eiferman, E. D. Peterson, F. H. Edwards, and R. S.D. Higgins Use of Both Internal Thoracic Arteries in Diabetic Patients Increases Deep Sternal Wound Infection Ann. Thorac. Surg., March 1, 2007; 83(3): 1002 - 1006. [Abstract] [Full Text] [PDF]