Anatomical study of the internal thoracic arteries; implications for use in coronary artery bypass graft surgery.
OBJECTIVE
The feasibility of coronary artery bypass grafting using an internal thoracic artery (ITA) depends on the length of the graft with respect to the optimal route to reach the coronary target. The goal of this study was to assess the gain in length afforded by skeletonization and to evaluate the lengths of different pathways of the ITAs to the left coronary arteries.


METHODS
The left and right ITAs were dissected out from 20 specimens and measured before and after skeletonization. Distance between the origin of the right ITA and the base of the left atrial appendage, corresponding to the proximal circumflex artery, was measured for both the transverse pericardial sinus and preaortic routes.


RESULTS
Skeletonization gave a significant gain of length for both ITAs. Analysis showed no significant correlation between the ITA length and the height, weight, and BMI of specimens. We found no association between the length of the sternum and the length of skeletonized RITA or LITA. The anterior route of the skeletonized right ITA was shorter than the transverse pericardial sinus route in 18 cases. The average length to the circumflex artery territory was 132.8 ± 23.5 mm in front of the aorta and 150.5 ± 18.8 through the transverse pericardial sinus with a gain of length of 17.7 mm (p < 0.0001).


CONCLUSIONS
Skeletonization gave significant gains in length of both ITAs. The preaortic route for the skeletonized right ITA toward the circumflex territory was shorter than the transverse pericardial sinus route in 90 % of cases.
Grenoble University Hospital, Pôle Thorax et Vaisseaux, Cardiac Surgery Clinic, 38000, Grenoble, France. ochavanon@chu-grenoble.fr.|Univ. Grenoble Alpes, HP2 Laboratory, 38000, Grenoble, France. ochavanon@chu-grenoble.fr.
Olivier
O
Chavanon
Univ. Grenoble Alpes, LADAF, Anatomical Laboratory, Grenoble University Hospital, 38000, Grenoble, France.
B
B
Romary
Grenoble University Hospital, Pôle Thorax et Vaisseaux, Cardiac Surgery Clinic, 38000, Grenoble, France.
C
C
Martin
Univ. Grenoble Alpes, LADAF, Anatomical Laboratory, Grenoble University Hospital, 38000, Grenoble, France.
P
P
Chaffanjon
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000033:anatomy & histology*; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000033:anatomy & histology*
Anatomy; Coronary artery bypass graft; Internal thoracic artery; Length; Skeletonized