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Abstract
The skeletonization technique of the internal thoracic artery (ITA) is used as a dissection
technique for myocardial revascularization procedures. This study compared free flow
between skeletonized ITA grafts and ITA pedicled grafts.
The ITA pedicled grafts were sprayed and wrapped in sponges soaked in dilute papaverine
solution in 14 patients and prepared with intraluminal papaverine injection in 18
patients. For 23 other patients, the ITA was skeletonized. We measured the first free
flow from the distal ITA early after the start of cardiopulmonary bypass and the second
free flow just before the ITA was grafted to the left anterior descending artery.
The first flow was greater in the skeletonized ITAs than in the ITA pedicled grafts
with topical application of papaverine alone (38.9 +/- 15.8 versus 18.0 +/- 6.8 mL/min;
p < 0.001). For the second flow, the pedicle grafts with intraluminal papaverine injection
and the skeletonized ITAs showed greater flow rate than the pedicled grafts with topical
application of papaverine (67.4 +/- 25.5 and 59.7 +/- 22.5 versus 38.1 +/- 13.1 mL/min;
p < 0.005 and p < 0.05, respectively), but there was no significant difference between
the former two groups (p = 0.53).
Skeletonization of the ITA is as efficient a strategy to increase the flow as intraluminal
papaverine injection for the ITA pedicled graft. When the ITA is harvested in a skeletonized
fashion, arterial spasm and reduced early flow can be avoided, even without intraluminal
injection of papaverine.