SEARCH · PubMed Health

Results for “THORACIC ARTERIES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources

PubMed2001

Incidental malignancy in internal thoracic artery lymph nodes.

The incidental finding of malignant internal thoracic lymph nodes while mobilizing the internal thoracic artery (ITA) for coronary bypass grafting has not to our knowledge been previously reported. The cases of 3 male patients who underwent surgery between January 1990 and January 1993 and in whom malignant lymph nodes were found in the ITA pedicle are reviewed. One individual was found to have metastatic carcinoma of the breast, whereas the other 2 were discovered to have previously undiagnosed lymphomas. After undergoing further relevant investigation and treatment, all 3 patients remain free of recurrent disease 6.8 to 9.8 years after their original cardiac surgery. Primary or metastatic malignancy may be encountered in the course of ITA mobilization for grafting. Abnormally enlarged internal thoracic lymph nodes should be sent for pathologic examination.

Aged↗

PubMedDate not supplied

Intraoperative duplex study of internal thoracic artery spasm during coronary bypass.

In this article, we document flow disturbance due to internal thoracic artery spasm (ITA) in a patient undergoing minimally invasive coronary artery grafting. We used intraoperative duplex scanning. Application of systemic vasodilators resulted in rapid improvement of ITA flow, as demonstrated by serial duplex examinations.

Coronary Artery Bypass↗

PubMed2000

Re-use of left internal thoracic artery for redo operation after MIDCAB.

We report a case of recycling of left internal thoracic artery (LITA) in situ in reoperation of coronary artery bypass grafting. A 41-year-old male, who has poor-controlled hypercholesterolemia, was bypassed LITA to the left anterior descending artery (LAD) in minimally invasive direct coronary artery bypass (MIDCAB) manner at the other hospital. Four months later, he felt short of breath on effort. Coronary angiogram showed stenoses of the left main trunk and anastomosis site of the LITA. At redo operation, we skeletonised the LITA and reused it in situ to the LAD. Using the skeletonised method for re-harvesting LITA made the graft reach a more distal portion without tension. He is doing well at 18 months after surgery. In selected patients, recycling of the used arterial grafts can reserve other arterial grafts for redo operations in the future.

Adult↗

PubMed1998

Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients?

BACKGROUND: The purpose of this study was to determine whether, with appropriate techniques, diabetic patients could benefit from the advantages of double internal thoracic artery (ITA) coronary bypass without an increased hospital risk. METHODS: Between January 1990 and December 1996, 207 consecutive diabetic patients underwent coronary artery bypass graft operations. In 74 patients both arteries (bilateral ITA group) were used, whereas 133 patients received one ITA and vein grafts or vein grafts alone (nonbilateral group). Patients in the bilateral ITA group were younger (p<0.0001), predominantly male (p<0.0001), and were operated on more electively. The internal thoracic arteries were harvested by skeletonization without electrocautery, and strict glycemic control was pursued. RESULTS: No death was observed in the bilateral ITA group, whereas 7 patients died in the nonbilateral ITA group (p<0.05). Deep sternal wound infection was observed in 2 patients in the nonbilateral ITA group (1.5%) and in none of the bilateral ITA group (p = NS). There was no significant difference in the morbidity rate between the two groups except for greater blood losses in the bilateral ITA group. CONCLUSION: Double ITA coronary revascularization in young diabetic patients was performed without increased morbidity and mortality. The low rate of sternal wound infections may be related to ITA harvesting by a skeletonization technique, but larger studies are required to confirm these data.

Case-Control Studies↗

PubMed2005

Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: six-year clinical outcome.

OBJECTIVES: We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar. METHODS: From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597). RESULTS: The overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P = .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 +/- 1.8 years. Forty-two patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 +/- 20.1 months, 202 patients had a postoperative angiography showing similar results. CONCLUSIONS: Our results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations.

Aged↗

PubMed1997

Atresia of internal thoracic artery grafts following placement to noncritically obstructed vessels.

Four patients postcoronary bypass surgery, utilizing the left internal thoracic artery as a jump graft, were found to have atresia of either the proximal segment (2 patients) or the distal interposition segment (2 patients) of this graft. In all 4 cases the atretic portion of the graft was the segment that had been anastomosed to a noncritically obstructed vessel. The segment anastomosed to the severely narrowed portion of the vessel functioned normally and approximated the target vessel size.

Adult↗

PubMedDate not supplied

Structural features of saphenous vein and internal thoracic artery endothelium: correlates with susceptibility and resistance to graft atherosclerosis.

Examination of saphenous vein (SV) and internal thoracic artery (ITA) endothelium at the time of coronary bypass surgery has confirmed the known susceptibility of SV to endothelial cell loss during preparation for grafting. In contrast the ITA showed only minimal cell loss. An ultrastructural morphometric analysis of the abluminal surface of the endothelium of both vessels showed significant differences in the numbers and depth of penetration of cytoplasmic processes or folds. Whereas the SV, perfusion-fixed at 110 mmHg, possessed relatively few (15/100 micron) and shallow (less than 1 micron deep) processes the ITA had significantly more (27/100 micron) and deeper (18% greater than 1 micron) processes. The ITA endothelial cells were also smaller and thicker. We suggest that the differences in the numbers and depth of the processes, which are believed to play a role in endothelial attachment, may account for the differing susceptibility of the two vessels to endothelial damage during grafting. This in turn correlates with the known susceptibility of SV grafts and resistance of ITA grafts to atherosclerotic changes.

Adult↗

PubMed1996

[The graft flow and 201Tl-myocardial scintigram in patients with saphenous vein graft or left internal thoracic artery graft].

To evaluate myocardial perfusion in patients with saphenous vein graft (SVG) or internal thoracic artery graft (ITA-G), we studied 38 patients (14: SVG, 10 males and 4 females, mean age 66 +/- 9 y-o; 24: ITA-G, 18 males and 6 females, mean age 64 +/- 7 y-o) by digital subtraction angiography (DSA) of ITA-G or SVG, and thallium-201 myocardial perfusion scintigraphy on exercise or dipyridamole stress. The grafting sites were left anterior descending artery (LAD) in all patients. Normal controls (n = 22) were defined by normal coronary angiogram and no evidence of myocardial ischemia. The graft flow and flow reserve on dipyridamole were measured by Rutishauser's formula. The basal blood flow of native normal ITA, SVG and ITA-G were respectively 72 +/- 24 ml/min, 51 +/- 23 ml/min, and 36 +/- 20 ml/min. The basal ITA-G flow was significantly lower than SVG-flow (p < 0.05). The flow reserves of SVG and ITA-G were respectively 2.32 +/- 0.65 and 1.78 +/- 0.59 (p < 0.02). The incidence of moderate hypoperfusion of thallium-201 SPECT was 14.3% in SVG and 12.5% in ITA-G on exercise stress, and 35% in SVG and 50% in ITA-G on dipyridamole stress. The incidence of reversible myocardial ischemia on dipyridamole stress was significant. The graft flow in patients with normal and abnormal thallium-201 SPECT were respectively 61 +/- 21 ml/min and 33 +/- 15 ml/min in SVG (p < 0.01), 46 +/- 19 ml/min and 27 +/- 16 ml/min in ITA-G (p < 0.02). The graft flow reserve were respectively 2.69 +/- 0.38 and 1.65 +/- 0.49 in SVG (p < 0.001), 2.25 +/- 0.40 and 1.31 +/- 0.28 in ITA-G (p < 0.001). We concluded that the basal blood flow and flow reserve of ITA-G were significantly lower than those of SVG. The myocardial ischemia was occasionally documented by the thallium-201 myocardial SPECT on dipyridamole stress in patients with patent ITA-G.

Aged↗

PubMed1999

Clinical anatomy of internal thoracic artery branches.

The broad clinical utilization of the internal thoracic artery (ITA), including the role of its branches in supplying circulation to the sternum, requires explicit anatomic knowledge of this vessel. Fifty-six ITAs (28 right, 28 left) were dissected from their point of origins after injection with a mixture of contrast medium and latex after perfusion with saline and immersion in 4% formaldehyde. All ITA branches were studied according to their course, size, and distribution within intercostal spaces with the aid of an operating microscope. The branches were divided in two main groups: proper (solitary) branches and common trunks. The proper branches consisted of four types: sternal, perforating, intercostal, and mediastinal. The four types of common trunks were: sternal/perforating, sternal/intercostal, perforating/intercostal, sternal/perforating/intercostal. Points of most frequent origin from main trunk of the vessel were established for each type. Mean external diameter of proper branches was 0.72 mm and common trunks was 1.06 mm. Mean length of common trunks was 3.0 mm. Those parameters (adequate diameter and length) allow for ligation of the common trunks close to the ITA so that their points of division can be preserved. This fact is crucial for creation of collateral blood supply to the sternum after bilateral ITA mobilizations.

Adolescent↗

PubMed2000

Clinical significance of internal thoracic artery morphometry and inter-ethnic differences.

The internal thoracic artery (ITA) is used extensively for coronary revascularisation. Clinical observations suggest an inter-ethnic difference in ITA morphometry between Indians and whites presenting for coronary artery bypass surgery. However, accurate morphometric data comparing these ethnic groups were not available. This study analyses the morphometry of the left and right ITAs in 60 cadavers (43 blacks, 9 whites, 8 Indians). The lengths of the arteries were measured and the external diameters were recorded at the origin of the 1st, 4th and 6th costal cartilages. Significant differences in length and diameter on the right and left sides between ethnic groups were demonstrated. In particular, these differences were marked between the white and Indian groups. Clinically, these differences can be so marked that in some instances the left ITA in Indian patients is so small at the distal point of take-down as to be unsuitable for use as an arterial conduit. This is one of the reasons that has prompted the use of the ITA as a composite graft. Our study appears to be the first to highlight this inter-ethnic difference and to support the clinical impression.

Journal Article↗

PubMed1998

Long-term survival benefit of internal thoracic artery grafting is negligible in a patient with bad ventricle.

BACKGROUND: Although the internal thoracic artery (ITA) graft is well known for its benefit of enhancing patient longevity after coronary artery bypass grafting (CABG), whether its superior patency is associated with improved patient survival at all levels of left ventricular function is unknown. The purpose of this study was to determine whether the use of ITA grafting during CABG confers improved survival benefit to patients with impaired preoperative left ventricular function. METHODS: A retrospective chart review was performed in 966 patients who had undergone isolated primary CABG between 1984 and 1995. The study population included 320 patients with only venous conduits (no-ITA group) and 646 patients with at least one ITA conduit (ITA group). A Cox partial likelihood approach was used to model the instantaneous mortality risk ratios as functions of ITA use and preoperative ejection fraction (EF). The forward stepwise regression model specifically examined the following potential confounders in the risk analyses: year of operation, patient age, weight, body surface area, graft location, number of grafts, perfusion time, ischemia time and Veterans Administration preoperative cardiac surgical risk estimates. RESULTS: Early (30-day) mortality in the ITA group (0.5%) was lower than the no-ITA group (4.1%) (p=0.0004). While 91% of the ITA group patients were still alive, only 70% of the no-ITA group patients were long-term survivors (p=0.0001). The ITA risk ratios for the increasing proportions of EF were not the same. In patients with E<0.40, the ITA risk ratio, 2.96, was significantly different (p=0.0001). It was only for EF >0.46, a significant survival benefit due to an ITA graft could be detected. The ITA-EF relationship was not confounded by the inclusion of those potential confounding variables in the model. CONCLUSIONS: Patient survival after CABG using an ITA graft may be affected by the level of preoperative EF. The internal thoracic artery-specific patient survival benefit appears to be less in a patient with poor left ventricular function.

Aged↗

PubMed1992

[Effective high frequency jet ventilation setting for the preparation of internal thoracic artery for coronary artery bypass graft surgery].

Effective high frequency jet ventilation (HFJV) setting during the preparation of internal thoracic artery (ITA) was estimated in 35 patients who underwent coronary artery bypass graft (CABG) surgery. During ITA preparation, ventilation with the minimum lung movement without circulatory deterioration is necessary. Therefore, appropriate frequency, inspiratory time interval (Ti%) and working pressure (WP) for HFJV were investigated. Rising WP and prolonged Ti% provoked increasing tidal volume and decreasing PaCO2, whereas the lung extension disturbed the ITA preparation. By modifying the settings of frequency, Ti% and WP, we determined the frequency of 3Hz and Ti% of 50%. The correlation between WP at normocapnia and bodyweight (BW) is expressed in the following formula: WP = 0.16 x BW - 0.0003 (r = 0.72) Moreover satisfactory recording of end-tidal CO2 could not be obtained during HFJV. Therefore, we used transcutaneous CO2 (tc-CO2) analyzer. The coefficient between tc-CO2 and PaCO2 was 0.95, and tc-CO2 was useful as a non-invasive monitoring of PaCO2. There was little change in blood pressure, heart rate and cardiac output during HFJV. However mean pulmonary artery pressure (mPAP) increased significantly during hypercapnia especially when PaCO2 was over 50 mmHg. This suggests that mPAP may be more sensitive to PaCO2 compared with other circulatory parameters. HFJV with these settings produced good outcome for ventilation and circulation during the preparation of ITA.

Adolescent↗

PubMed1996

Skeletonized and pedicled internal thoracic artery grafts: effect on free flow during bypass.

BACKGROUND: The skeletonization technique of the internal thoracic artery (ITA) is used as a dissection technique for myocardial revascularization procedures. This study compared free flow between skeletonized ITA grafts and ITA pedicled grafts. METHODS: The ITA pedicled grafts were sprayed and wrapped in sponges soaked in dilute papaverine solution in 14 patients and prepared with intraluminal papaverine injection in 18 patients. For 23 other patients, the ITA was skeletonized. We measured the first free flow from the distal ITA early after the start of cardiopulmonary bypass and the second free flow just before the ITA was grafted to the left anterior descending artery. RESULTS: The first flow was greater in the skeletonized ITAs than in the ITA pedicled grafts with topical application of papaverine alone (38.9 +/- 15.8 versus 18.0 +/- 6.8 mL/min; p < 0.001). For the second flow, the pedicle grafts with intraluminal papaverine injection and the skeletonized ITAs showed greater flow rate than the pedicled grafts with topical application of papaverine (67.4 +/- 25.5 and 59.7 +/- 22.5 versus 38.1 +/- 13.1 mL/min; p < 0.005 and p < 0.05, respectively), but there was no significant difference between the former two groups (p = 0.53). CONCLUSIONS: Skeletonization of the ITA is as efficient a strategy to increase the flow as intraluminal papaverine injection for the ITA pedicled graft. When the ITA is harvested in a skeletonized fashion, arterial spasm and reduced early flow can be avoided, even without intraluminal injection of papaverine.

Adult↗

PubMed1997

Lateral origin of the right internal thoracic artery: report of a case.

We report herein the unusual case of a patient in whom postoperative angiography following coronary artery bypass grafting (CABG) revealed a lateral origin of the right internal thoracic artery (ITA) and a normal origin of the left ITA, both of which were demonstrated to be patent and did not follow a tortuous course. The CABG had involved revascularization of the left anterior descending artery (LAD) with the right ITA, and the obtuse marginal artery with the left ITA. The patient had an uneventful postoperative course and developed no respiratory symptoms.

Coronary Angiography↗

PubMed1996

Evaluation of cyropreserved internal thoracic artery as an alternative coronary graft: evidence for preserved functional, metabolic and structural integrity.

The internal thoracic artery (ITA) is the conduit of choice for coronary artery bypass grafting (CABG). This study, utilizing a canine model, evaluates cryopreserved ITA. Sixteen ITAs were harvested and cryopreserved according to United CryoInstitute protocol. Test conduits, 5 cm long and 4 mm mean diameter, were anastomosed to the ligated carotid artery of an unmatched mongrel recipient, above and below the site of native artery ligation. Graft patency was assessed by angiography at 14 days (early) and 980 days (late) postoperatively. Catheterization of the 16 vessels identified three (18%) early and one (6%) late graft occlusion. Ninety days postoperatively, each dog was killed and the graft harvested for histopathological and functional evaluation. Morphologic evaluation, using conventional staining, showed preserved cellular structure, decrease in smooth muscle cells and distorted endothelial layer. Immunocytochemistry, using an antibody against prostacyclin (PGI2), detected PGI2 immunoactivity in the ITA smooth muscle cells. An in vitro assay performed on the arterial rings confirmed preserved functional integrity of the vascular endothelium and smooth muscle. These findings suggest that cryopreserved ITA may have potential as a substitute graft, in devising conduit strategies for primary or reoperative coronary bypass surgery.

Animals↗

PubMed1999

Myocardial revascularization with the left internal thoracic artery Y graft configuration.

BACKGROUND: The proved long-term patency of the left internal thoracic artery (LITA) has made it the conduit of choice for myocardial revascularization. Maximal utilizable LITA length can be achieved by using a semiskeletonizing harvest technique. Expanded LITA use with sequential and Y graft techniques allows for a wider territory of myocardial revascularization. METHODS: A retrospective analysis of 30 patients undergoing coronary artery bypass surgery with a LITA-Y graft between December 1994 and November 1996 was performed. In selected patients the LITA was cut to length and anastomosed to the left anterior descending artery (LAD), with the redundant length of LITA used as a free graft to the lateral circumflex and diagonal systems. The proximal end of the free LITA was anastomosed to the in situ LITA to form the Y graft. Selection criteria included: a) minimal distal disease in the LAD and circumflex systems; and b) graftable circumflex branches proximal to the mid free wall of the left ventricle, allowing total revascularization of the left coronary system with the Y graft. RESULTS: Thirty patients (22 male, 8 female) underwent the LITA-Y graft procedure. There were no deaths or episodes of myocardial infarction. One patient required inotropic and intraaortic balloon pump support. Two patients with isolated coronary ostial stenosis developed recurrence of angina due to occlusion of the free limb of the LITA. CONCLUSIONS: In patients with suitable coronary artery anatomy, the LITA-Y graft can be successfully performed with good short-term outcome, but may be contraindicated in the management of isolated coronary ostial stenosis.

Aged↗

PubMed1994

Bovine internal thoracic artery graft for myocardial revascularization: late results.

From May 1988 to March 1990, the bovine internal thoracic artery (ITA) graft, 3 mm in diameter, was used for coronary artery bypass grafting in 29 patients with the approval of the Japanese Ministry of Health. Excluding three postoperative deaths and 6 patients who rejected postoperative angiography, 20 patients (13 men and 7 women; mean age, 62 years; range, 37 to 80 years) were followed up angiographically for up to 4 years. Sites of bovine ITA anastomosis were as follows: anterior descending, 4; circumflex, 5; and right coronary artery, 11. The mean bovine ITA graft blood flow measured by electromagnetic flowmeter was 75.2 mL/min (range, 40 to 150 mL/min). During the mean follow-up of 45 months (range, 30 to 52 months), 12 patients underwent postoperative angiography once, 6 patients twice, and 2 patients three times. It revealed 14 of 16 (88%) bovine ITA grafts were patent within 2 postoperative months. Three of 6 (50%) were patent at 3 to 12 months, of which 2 patent grafts required balloon angioplasty for distal anastomotic stenosis. In 7 patients restudied later than 1 year (20, 24, 25, 44, 48, 50, and 52 months), one of seven grafts (14%) was patent. There was stenosis (> or = 50%) at four distal and one proximal bovine ITA anastomotic sites, but no focal stenosis was found in the trunk at any period. There was one late death due to renal failure, one myocardial infarction, and one mild angina due to bovine ITA graft failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

A pathohistological and biochemical study of arteriosclerosis in the internal thoracic artery, a vessel commonly used as a graft in coronary artery bypass surgery.

Pathohistological and biochemical studies were conducted on the severity of arteriosclerosis in the internal thoracic artery (ITA), an artery commonly used for coronary artery bypass grafting (CABG). For the pathohistological examination, 26 bilateral ITAs and 13 left anterior descending coronary arteries (LADs) obtained in full length from 13 autopsy cases, none of which had died of arteriosclerotic heart disease, were used. The ratio of the thickness of the intima to that of the media (R) was used as the index for arteriosclerosis. ITAs and LADs were classified as grades I to IV according to the value of R. The R of the ITAs was approximately 1/10 that of the LADs (P < 0.01). Most ITAs showed a low arteriosclerotic grade, with no variation in arteriosclerosis along their length and a low R in all segments. No difference was found between right and left ITAs. Biochemical examination was conducted on 12 ITAs and 11 LADs, obtained from 12 different and unselected autopsy cases. The lipid content in the vascular wall was determined to evaluate the severity of arteriosclerosis, with the following results: Total cholesterol, 5.5 +/- 1.8 and 17.8 +/- 13.6 micrograms/mg wet weight (P < 0.05); triglyceride, 90.4 +/- 90.3 and 114.4 +/- 117.2 micrograms/mg wet weight (n.s.); and phospholipid, 7.4 +/- 3.9 and 11.2 +/- 3.9 micrograms/mg wet weight (P < 0.05), respectively, for the ITAs and LADs. These findings thus demonstrate that arteriosclerosis of the ITA in Japanese people is very mild, compared to that of the LAD in the same individuals.

Adult↗