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
patients
whose graft was injured during mobilization, the first flow of IMA graft was 32.3*7.4 ml/min and the second flow increased to 59.6*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*26.9 mg/min versus 37.7*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*25.9 ml/min versus 74.7*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.
(Korean J Thorac Cardiovasc Surg 1995;28:671-7)
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