The Advantages Of Skeletonized Internal Thoracic Artery’s Application In Coronary Artery Bypass Grafting

Objectives To investigate the effects of skeletal internal thoracic artery(ITA)or pedicled internal thoracic artery on intraoperative bridging vessel flow and patency rate and postoperative chest wall pain and paresthesia in patients undergoing coronary artery bypass grafting(CABG).Methods Seventy patients with coronary artery bypass grafting under extracorporeal circulation were retrospectively analyzed.Among them,36 patients had skeletonized internal thoracic artery grafts and 34 patients had pedicled internal thoracic artery grafts.A questionnaire survey was conducted 1 month and 1 year after surgery.Results There were no significant difference in the mean flow and pulse index of internal thoracic artery grafts between skeletonized ITA grafts 42(33,53.5)m L/min,2.75(2.15,3.6)and pedicled ITA grafts 41(27,51)m L/min,3.1(2.2,3.6)(all P values>0.05).At 1 month postoperatively,the pain disability index was lower in the skeletonized ITA graft group 3(2,3)than in the pedicled ITA graft group 5(4,5),and the difference was statistically significant(P<0.05),one year after surgery,the pain disability index of the skeletonized internal thoracic artery graft group was 0(0,0),and that of the pedicled internal thoracic artery graft group was 0(0,0),the difference was not statistically significant(P > 0.05).The incidence of paresthesia was lower in the skeletonized ITA graft group than in the pedicled ITA graft group at 1month and 1 year postoperatively,with statistically significant differences(all P values<0.05).Conclusions Skeletonized ITA grafts can provide bridging flow and pulse index(fluid resistance)similar to pedicled ITA grafts.Early postoperative,skeletonization of the internal thoracic artery can reduce the incidence of chest wall paresthesia and reduce postoperative pain.In the long term,skeletonization of the internal thoracic artery can reduce the incidence of postoperative chest wall paresthesia,but does not reduce post CABG pain(PCP).