Why is the internal mammary artery used for grafts?
The internal mammary artery (IMA) grafts have been associated with long-term patency and improved survival as compared to saphenous vein grafts (SVGs). Early failure of IMA is attributed to poor surgical technique and less with thrombosis.
What type of graft is the internal mammary artery graft?
As the most commonly used bypass grafts, the internal thoracic (mammary) artery (ITA) grafts show the best long-term results. In most cases, the artery is left intact at its origin, with the opposite end sewn to the coronary artery below the site of the blockage.
What is atherosclerosis of bypass graft?
Atherosclerosis is the most frequent cause of occlusion of aortocoronary saphenous vein grafts between 5 and 10 years after coronary artery bypass surgery.
How is internal mammary artery harvested?
As the fascia is pulled down with forceps, the vein is exposed using the electrocautery tip. When the under-surface of the vein is clearly exposed, the artery subsequently becomes visible. The cautery tip gently separates the vein and IMA. The trunk of the IMA is separated from the chest wall gradually.
What is the function of internal mammary artery?
The internal thoracic artery, aka the internal mammary artery, supplies the breast and the anterior chest wall. The internal thoracic artery travels along the inner surface of the anterior chest wall on both sides.
What does internal mammary artery supply?
In human anatomy, the internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts.
How does CABG work?
CABG uses blood vessels from another part of the body and connects them to blood vessels above and below the narrowed artery, bypassing the narrowed or blocked coronary arteries. One or more blood vessels may be used, depending on the severity and number of blockages.
How long does a mammary artery bypass last?
Lets summarize the article so far. If a patient has a LIMA bypass, it is almost 90% likely to remain open, even 10 years after the operation, and that is just great. For the other blockages where an SVG graft is used, the bypasses are about 50% likely to remain open at 10 years.
Where is the internal mammary artery located?
It is located about two to three centimeters on either side of the sternum and is slightly medial to the nipple. It is almost always accompanied by the large internal thoracic veins that also follow the same course.
Where does the internal mammary artery come from?
The IMAP flaps, as the name implies, derive from the internal mammary artery (IMA). The IMA originates from the subclavian artery and travels along the sternal border on each side of the sternum. It becomes the superior epigastric artery in the upper abdomen and nourishes the upper part of the rectus abdominis muscle.
What is internal mammary chain?
The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces.
Which is better internal mammary artery or pedicled graft?
Skeletonized internal mammary graft vs pedicled graft. Internal mammary artery (IMA) grafting is an important part of coronary artery bypass grafting. Arterial grafts give longer survival benefits compared to venous grafts. The conventional technique of IMA grafting uses pedicled grafts. Of late, skeletonized grafts are becoming more popular.
Is it possible to skeletonize the mammary artery?
The answer is: in 8 years, for 815 patients with 1363 harmonically skeletonized mammary arteries – NO. If a branch is to bleed, it will have done so before the end of the case. Additional advantages of using the harmonic to skeletonize the mammary artery render it relatively “clip-less”.
Which is better skeletonization or pedicled IMA graft?
Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of the IMA can minimize sternal ischemia and lower the risk of mediastinitis, and the graft is longer and larger than a pedicled IMA.
What happens to the internal mammary artery during mobilization?
Because the internal mammary artery is a delicate structure, any undue stretching, clamping, or misplaced clips results in permanent vascular injury and therefore unsatisfactory short- and long-term results. Excessive traction during mobilization should be avoided as it can lead to dissection of the vessel wall.