On Free Right Internal Thoracic Artery in a "Horseshoe" Configuration: A New Technical Approach for "In Situ" Conduit Lengthening

2005 ◽  
Vol 20 (6) ◽  
pp. 585-585
Author(s):  
Stephen E. Fremes
Keyword(s):  
Internal Thoracic Artery ◽  
Technical Approach ◽  
Right Internal Thoracic Artery

Free Right Internal Thoracic Artery in a "Horseshoe" Configuration: A New Technical Approach for "In Situ" Conduit Lengthening

2005 ◽  
Vol 20 (6) ◽  
pp. 583-584
Author(s):  
Jacob Zeitani ◽  
Alfonso Penta de Peppo ◽  
Antonio Scafuri ◽  
Francesco Versaci ◽  
Luigi Chiariello
Keyword(s):  
Internal Thoracic Artery ◽  
Technical Approach ◽  
Right Internal Thoracic Artery

scholarly journals Bilateral internal thoracic artery grafting: propensity analysis of the left internal thoracic artery versus the right internal thoracic artery as a bypass graft to the left anterior descending artery

2019 ◽  
Author(s):  
Shinji Ogawa ◽  
Tomohiro Tsunekawa ◽  
Soh Hosoba ◽  
Yoshihiro Goto ◽  
Takayoshi Kato ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Chronic Obstructive ◽  
Left Internal Thoracic Artery ◽  
Left Anterior Descending Artery ◽  
Statistical Adjustment ◽  
Right Internal Thoracic Artery

Abstract OBJECTIVES To compare different configurations of the bilateral internal thoracic arteries for the left coronary system and examine early and late outcomes, including mid-term graft patency. METHODS We reviewed 877 patients who underwent primary isolated coronary artery bypass grafting using in situ bilateral internal thoracic arteries [in situ right internal thoracic artery (RITA)-to-left anterior descending artery (LAD) grafting, n = 683; in situ left internal thoracic artery (LITA)-to-LAD grafting, n = 194]. We compared mid-term patency between the grafts. Propensity score matching was performed to investigate early and long-term outcomes. RESULTS The 2-year patency rate for RITA-to-LAD and LITA-to-LAD grafts were similar. Multivariate analysis revealed that RITA-to-non-LAD anastomosis (P = 0.029), postoperative length of stay (P = 0.003) and chronic obstructive pulmonary disease (P = 0.005) were associated with graft failure. After statistical adjustment, 176 propensity-matched pairs were available for comparison. RITA-to-LAD grafting enabled a more distal anastomosis. Kaplan–Meier analysis revealed that the incidences of death, repeat revascularization and myocardial infarction were significantly higher in the LITA-to-LAD group among both the unmatched and matched samples (P = 0.045 and 0.029, respectively). CONCLUSIONS The mid-term patency and outcomes of RITA-to-LAD grafting are good and reduces future cardiac event, in contrast to LITA-to-LAD grafting.

In-situ left-sided bilateral internal thoracic artery: elevated hemidiaphragm

2018 ◽  
Vol 26 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Oren Lev-Ran ◽  
Dan Abrahamov ◽  
Nina Baram ◽  
Menachem Matsa ◽  
Yaron Ishai ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Phrenic Nerve ◽  
Internal Thoracic Artery ◽  
Statistical Significance ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Phrenic Nerve Injury ◽  
Right Internal Thoracic Artery ◽  
Bilateral Internal Thoracic Artery

Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively. Elevated hemidiaphragm was assessed by serial chest radiographs and categorized by side, complete (≥2 intercostal spaces) versus partial, and permanent versus transient. Results Right elevated hemidiaphragm occurred in 4.2% of patients. The incidence of radiological complete right elevated hemidiaphragm was 2.8% (12/432); 8 cases were transient with recovery in 3.5 ± 0.3 weeks. Permanent right elevated hemidiaphragm occurred in 0.9% (retroaortic group only). Permanent left elevated hemidiaphragm occurred in 0.9% and was significantly higher in the ante-aortic group (3/99 vs. 1/333, p = 0.039). No bilateral hemidiaphragm elevation was documented. Partial right elevated hemidiaphragm occurred in 1.4% and was not associated with adverse early or late respiratory outcomes. Conclusions Despite susceptible right phrenic nerve-internal thoracic artery anatomy, the incidence of permanent right elevated hemidiaphragm is low and no higher than left-sided in prone bilateral internal thoracic artery subsets. This reflects skeletonized internal thoracic artery procurement. Although statistical significance was not achieved, a retroaortic right internal thoracic artery configuration may constitute a higher risk of right phrenic nerve injury.

scholarly journals A non-conventional proximal inflow for the radial artery coronary graft

2020 ◽  
Vol 31 (2) ◽  
pp. 179-181
Author(s):  
Giuseppe Gatti ◽  
Pierpaolo Taffarello ◽  
Jasmina De Groodt ◽  
Bernardo Benussi
Keyword(s):  
Radial Artery ◽  
Internal Thoracic Artery ◽  
Myocardial Revascularization ◽  
Composite Graft ◽  
Reliable Information ◽  
Right Internal Thoracic Artery ◽  
Proximal Stump ◽  
Limited Series ◽  
Storage Solution

Abstract Despite good outcomes, the use of the radial artery as a coronary graft is not widespread. Concerns regarding its low versatility and the risk of hand ischaemia, as well as the lack of reliable information regarding the best storage solution of the graft, and regarding the treatment for preventing spasms have limited its use. In this manuscript, the (numerous) benefits and (few) drawbacks of the proximal inflow for the radial artery from the in situ right internal thoracic artery proximal stump are discussed. Outcomes are reported from a limited series of patients undergoing totally arterial myocardial revascularization using this composite graft and both internal thoracic arteries.

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