EFFECT OF SKELETONIZING DISSECTION ON THE INTERNAL THORACIC ARTERY

Background. Skeletonization of the internal thoracic artery (ITA) prod uces greater length for coronary bypass grafting. We studied the effec t of skeletonization on the morphology, histology, and tissue viabilit y of the ITA wall. Methods. Six mongrel dogs underwent unilateral ITA dissection; the contralateral ITA was the control. Study periods were 3 weeks (n = 3) and 12 weeks (n = 3). At sacrifice, the entire anterio r chest wall was removed and dynamically fixed with formalin. Extensiv e histologic comparisons were performed on three tissue blocks taken f rom each ITA, 2, 8, and 24 cm from their origin. Results. Flows at the end of the study were comparable to measurements taken during operati on, immediately after skeletonization. Grossly, the ITA wall was not i njured by skeletonization and there was no adventitial hematoma or ble eding from the sealed branch ends. Microscopic observations showed int act, normal wall structures. Histologic data showed no major significa nt difference between controls and skeletonized ITAs. Conclusions. Car eful skeletonizing dissection is not detrimental to the integrity of I TAs, which justifies their use for myocardial revascularization. (C) 1 998 by The Society of Thoracic Surgeons.