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J Thorac Cardiovasc Surg 2001;121:1219-1220
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Amram J. Cohen, MD

Department of Cardiovascular Surgery
Edith Wolfson Medical Center
Holon, Israel

Reply to the Editor:

I agree with Casha and Gauci that the reason for lack of ischemia to the ipsilateral internal thoracic artery (ITA) while harvesting a skeletonized ITA is the avoidance of damage to collateral vessels. I thank them for citing a reference that explains this phenomenon anatomically.Go 1

Concerning venous return, since our publication, we have harvested the ITA with only the accompanying veins in a separate group of patients and have performed scans before and after the operations. We found no ischemia of the hemisternum in this group, as in the skeletonized group. Therefore, we believe that preservation of the arterial collaterals is the key to avoiding hemisternal ischemia after ITA harvest. Preservation of venous return plays a minimal role, if any at all, in sternal ischemia after ITA harvest.

12/8/113929doi:10.1067/mtc.2001.113929

Reference

  1. Pietrasik K, Bakon L, Zdunek P, Wojda-Gradowska U, Dobosz P, Kolesnik A. Clinical anatomy of internal thoracic artery branches. Clin Anat 1999;12:307-14.[Medline]




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