Skeletonized internal mammary graft vs pedicled graft

Skeletonized internal mammary graft vs pedicled graft Internal mammary artery (IMA) grafting is an important part of coronary artery bypass grafting. Arterial grafts give longer survival benefits compared to venous grafts. The conventional technique of IMA grafting uses pedicled grafts. Of late, skeletonized grafts are becoming more popular. The proposed advantage of skeletonized grafts is that when bilateral IMA grafts are used, there is less compromise on sternal vascularity and risk of deep sternal infections. Deep sternal infections are always a concern when using bilateral IMA grafts and can occasionally lead to sternal wound dehiscence. Pedicled graft is harvested en-block including the associated veins and surrounding adipose tissue. Metal clips and electrocautery are used for harvesting. Vasospasm is prevented by spraying papaverine and intraluminal injection of milrinone [1]. Skeletonized graft is prepared using ultrasonic harmonic scalpel. The fascia around the artery is opened, vein and surrounding tissue are removed. Side branch bleeding is also controlled by the ultrasonic scalpel. Vasospasm is prevented as in case of pedicled graft. It is thought that skeletonization may preserve sternal perfusion better, especially in diabetic patients [2]. While pedicled grafts are typically used to graft one artery, skeletonized grafts have better mobilised length and can be used to graft multiple vessels as well as more distal coronary territories. Proponents of total arteri...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Pedicled internal mammary graft Skeletonized internal mammary graft Skeletonized LIMA graft Source Type: blogs