Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Coronary Artery bypass Surgery Using Skeletonization Technique of Left Internal Mammary Aartery

관상동맥 우회술시 근막 및 정맥 등 주위조직이 없는 좌내흉동맥편의 이용

  • Published : 1995.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Skeletonization of the internal mammary artery [IMA during myocardial revascularization procedures may provide some advantages, compared with the pedicle graft of the artery. In 17 patients undergoing IMA grafting by skeletonization technique, flow through the artery was measured on mean arterial pressure of 50-55 mmHg immediately after cardiopulmonary bypass started [first flow and just before its anastomosis to left anterior descending artery [second flow . In 16 patients except 1 patient whose graft was injured during mobilization, the first flow of IMA graft was 32.3 $\pm$ 7.4 ml/min and the second flow increased to 59.6$\pm$25.9 ml/min without any treatment and the site for anastomosis of the IMA graft was more than 1.0 cm above the bifurcation. On the basis of previous clinical studies, the flow of the skeletonized IMA was greater than that of the pedicle graft [59.6 $\pm$ 25.9 ml/min versus 37.7$\pm$ 14.1 ml/min, p < 0.05 . In comparison between the skeletonized IMA and the IMA graft intraluminally dilated with papaverine solution, there was no significant difference between two flows[59.6 $\pm$25.7 ml/min versus 74.7 $\pm$31.4 ml/min, not significant , but the former showed longer graft and anastomosis of more proximal portion of the graft to left anterior descending artery. In conclusion, the technique of internal mammary artery skeletonization has consistently produced a satifactory conduit for myocardial revascularization procedures. We have adopted IMA skeletonization not only because of the flow, diameter, and vessel length obtained but also because of limited perivascular tissue disruption that occurs during the dissection.

Keywords

References

  1. N Engl J Med v.314 Influence of the internal mammary artery graft on 10-year survival and other cardiac events Loop,F.D.;Lytle,B.W.;Cosgrove,D.M.(et al.)
  2. J Thorac Cardiovasc Surg v.86 Long-term fate of the internal mammary artery and saphenous vein grafts Sing,R.N.;Sosa,J.A.;Green,G.E.
  3. Circulation v.74 no.Sup.3 Bypass surgery with internal mommary artery graft : 15 year follow-up Cameron,A.;Kemp,H.G.;Green,G.E.
  4. Ann Thorac Surg v.42 Healing basis and surgical techniques for complete revascularization of the left ventricle using only the internal mammary arteries Sauvage,L.R.;Wu,H.D.;Kowalsky,T.E.(et al.)
  5. Ann Thorac Surg v.54 Considerations in the skeletonization technique of internal thoracic artery dissection. Cunningham,J.M.;Gharavi,M.A.;Fardin,R.;Meek,R.A.
  6. 대흉외지 v.25 좌주관 관상동맥 질환의 외과적 치료 홍종면;채 헌;조준량
  7. 대흉외지 v.25 관상동맥 우회술 32례의 임상적 고찰 김학제;이 건;황재준(등)
  8. 대흉외지 v.26 관상동맥 우회술. 심마비액을 사용하지 않은 수술방법 서동만;송명근
  9. 대흉외지 v.25 관상동맥 우회술후 이식혈관의 개존 노환규;박영환;장병철
  10. 대흉외지 v.25 내경확장을 시행하지 않은 내유동맥을 이용한 관상동맥 우회로술의 임상적 결과 최종범;윤재도;박양규;박옥규
  11. 대흉외지 v.26 관상동맥 우회로술에서 내유동맥 이식편의 처치방법에 따른 문합전 내유동맥 혈류량의 비교. 최종범;김형곤;정진원
  12. J Thorac Cardiovasc Surg v.63 Myocardial revascularization by internal mammary artery grafts. A technique without optical assistance Loop,F.D.;Effler,D.B.;Spampinato,N.(et al.)
  13. J Cardiovasc Surg (Torino) v.30 Prospective study of the feasibility of routine use of multiple internal mammary artery anastomoses Green,G.E.;Sosa,J.;Cameron,A.
  14. J Cardiovasc Surg (Torino) v.30 Sequential mammary artery grafts in one hundred and twenty consecutive patients: indications, operative technique, 6 months postoperative functional and angiographic controls Dion,R.A.;Verhelst,R.;Goenen,M.(et al.)
  15. J Thorac Cardiovasc Surg v.86 Sequential internal mammary-coronary artery bypass Kabbani,S.S.;Hanna,E.S.;Bashour,T.T.(et al.)
  16. Surgery of the chest.(5th ed.) Sabiston,D.C.;Spencer,F.C.
  17. Ann Thorac Surg v.49 Seventeen-year experience with bilateral internal mammary artery grafts Galbut,D.L.;Traad,E.A.;Dorman,M.J.(et al.)
  18. Ann Thorac Surg v.44 Anatomical studies to support the expanded use of the internal mammary artery graft for myocardial revascularization Landymore,R.W.;Chapman,D.M.
  19. Am J Surg v.137 Early and late results of coronary revascularization with saphenous vein and internal mammary artery grafts Geha,A.S.;Baue,A.E.
  20. J Thorac Cardiovasc Surg v.102 Dissection of the two internal mammary arteries with maximal exposure and minimal adverse sequelae by means of an inexpensive, simple, atraumatic retractor Brown,A.H.;Dougenis,D.
  21. Contractility of the human internal mammary artery He,G.W.
  22. J Thorac Cardiovasc Surg v.102 Dissection of the two internal mammary arteries with maximal exposure and minimal adverse sequelae by means of an inexpensive, simple, atraumatic retractor. Brown,A.H;Dougenis,D.