Can internal thoracic arteries be used for both coronary artery bypass and breast reconstruction?
OBJECTIVE
Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG).


METHODS
Anatomic analysis of 20 female patients undergoing CABG was performed examining internal thoracic artery length from its origin to the third, fourth, fifth intercostal spaces and the left anterior descending (LAD) artery target.


RESULTS
The left internal thoracic artery was anastamosed to the LAD target at a mean length of 11.4 ± 1.4 cm. The mean lengths of the pedicled left internal thoracic artery from its origin to the third, fourth and fifth intercostal space were 8.5 ± 1.0, 10.9 ± 1.2 and 13.0 ± 1.4 cm, respectively. Therefore, the left internal thoracic artery length was adequate at the fourth intercostal space in 6 of 20 (30%) patients.


CONCLUSIONS
Dissection of the left internal thoracic artery to the fourth intercostal space would allow for concomitant use in CABG and breast reconstruction in one-third of cases. However, skeletonization of the internal thoracic artery at the level of the fourth intercostal space would be sufficient for CABG in all cases following autologous breast reconstruction.
Division of Cardiac Surgery, Department of Surgery,  University of Western Ontario, London Health Sciences Centre, London, ON,  Canada.
Maria E
ME
Currie
Stephanie A
SA
Fox
Rebecca J
RJ
Greer-Bayramoglu
Amanda J
AJ
Fortin
Michael W A
MW
Chu
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D004210:Dissection; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000033:anatomy & histology / Q000601:surgery*; D008875:Middle Aged