title: Pitfalls of skeletonized internal thoracic artery: comparison of graft kinking between skeletonized and pedicled grafts based on postoperative angiography findings.
abstract: OBJECTIVE
  Skeletonization of the internal thoracic artery (ITA) has several advantages: sequential bypass grafting can be easily performed, and a graft of increased length can make the distal coronary artery accessible. However, kinking of the grafts has been observed on postoperative angiograms in a few cases. We investigated whether there were significant differences in the frequency of graft kinking and stenosis degree at the kink site between pedicled and skeletonized grafts.
  
  
  METHODS
  Postoperative angiography was performed for all cases. In pedicled (n = 65) and skeletonized (n = 129) groups, the results of postoperative graft angiography were analyzed to investigate the presence of graft kinking and stenosis degree at the kink site.
  
  
  RESULTS
  Kinking was observed in 4 (5.9%) and 9 (3.9%) arteries in the pedicled and skeletonized groups, respectively (p = 0.341). The stenosis degree at the kink site (mean +/- SD) was significantly higher in the skeletonized group (47.2 +/- 16.8%) than in the pedicled group (23.5 +/- 13.7%), (p = 0.032). In four patients in whom early postoperative angiography showed a kink with more than 50% stenosis, late-term angiography was performed. All four cases showed regression of the stenosis degree at the kink site.
  
  
  CONCLUSIONS
  When the ITA had a kink, the stenosis degree at the kink site was significantly higher in the skeletonized group than in the pedicled group. Late angiography often reveals regression of stenosis at the kink site. Immediate intervention need not always be performed if the patient has no angina caused by a stenotic lesion at the kink site.
authors.affiliation: Department of Cardiovascular Surgery, Chiba University Hospital, Inohana, Chiba City, Japan. imamaki-cuh@umin.ac.jp
authors.forename: Mizuho
authors.initials: M
authors.lastname: Imamaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakurai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ishida
authors.forename: Hisanori
authors.initials: H
authors.lastname: Fujita
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged