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J Thorac Cardiovasc Surg 1996;111:490
© 1996 Mosby, Inc.

Letters to the Editor

Skeletonization of internal thoracic artery grafts

Magdi Yacoub, FRCS, Sudhir S. Kushwaha, MD

National Heart and Lung Institute
Harefield, Middlesex
UB9 6JH, United Kingdom

Reply to the Editor:

We appreciate Dr. J. M. Cunningham's comments and agree that skeletonization is a technique relatively frequently used by us and others to enable the pedicled internal thoracic artery to reach more peripheral sites. Although this technique increases the chances of using a pedicled graft, to our knowledge its effect on endothelial function has not been studied. We agree with Dr. Cunningham that avoiding the use of diathermy near the vessel can (at least in theory) prevent or minimize endothelial damage. The effect of stripping the adventitia and stretching the artery, or the vessel wall in general and the endothelium in particular, remains unknown. Provision of data regarding this could be a welcome addition to the literature.

The almost unique structural and functional characteristics of the internal thoracic artery, coupled with its documented superior performance as a bypass graft, warrant efforts aimed at maximizing its use.





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