PubMed Health⌕ Search

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 91 records · Page 5Linked to original sources
PubMed1997

[Emergency coronary artery bypass grafting using the internal thoracic artery graft after percutaneous transluminal coronary angioplasty in a patient with left main coronary artery disease associated with acute myocardial infarction].

A 66-year-old woman suffering acute myocardial infarction developed cardiogenic shock during urgent coronary angiography, which demonstrated a subtotal occlusion of the left main coronary artery and the triple-vessel coronary artery disease. The patient survived, after prompt percutaneous transluminal coronary angioplasty for the left main coronary artery disease, followed by emergency triple-vessel coronary artery bypass grafting using the internal thoracic artery graft for the left anterior descending artery. Postoperative angiography demonstrated well patent bypass grafts with good preservation of left ventricular function.

Aged↗
PubMed2002

Comparison of the endothelial surface and subjacent elastic lamina of anterior descending coronary arteries at the location of atheromatous lesions with internal thoracic arteries of the same subjects: a scanning electron microscopic study.

AIM: Current theories fail to explain the localisation of atheromatous lesions or their variable incidence in different arteries of the same subject. The objective of this study was to compare by scanning electron microscopy (SEM) the endothelial surface and the subjacent elastic lamina of human coronary arteries at the location of areas showing infiltration by lipid and cells, with the same components of internal thoracic arteries of the same subjects. METHODS: The endothelial surface and the subjacent elastic lamina of localised atheromatous areas of 146 anterior descending coronary arteries were compared with the same structural components of the internal thoracic arteries of the same subjects, using SEM, transverse paraffin sections and freeze-fracture. Some arteries were digested with formic acid to destroy the endothelium and interstitial tissue, and reveal the elastin fibre structure of the elastic laminae. RESULTS: Coronary arteries showed localised defects of the endothelial surface and of the elastin fibre structure of the subjacent elastic membrane, with the presence of lipid and cells in transverse sections of the intima. Internal thoracic arteries showed such changes only rarely, more particularly in older age groups. CONCLUSIONS: In localised areas of the coronary arteries showing infiltration of the wall by lipid and cells, there were imperfections of the endothelial surface and of the elastin fibre structure of the subjacent elastic lamina. These imperfections were not in general present in the endothelial surface, or subendothelial elastic lamina of the internal thoracic arteries in age groups below 50, and only rarely in older subjects.

Adolescent↗
PubMed2004

Robotic skeletonizing of the internal thoracic artery: is it safe?

BACKGROUND: The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). METHODS: Nine dogs underwent bilateral robotic internal thoracic artery harvesting through three ports placed in the left chest. One internal thoracic artery was harvested as a pedicle in each dog, and the other was skeletonized. Internal thoracic artery blood flow was measured in each graft, and comparative endothelial histologic studies were performed. Data are mean +/- the standard error of the mean. RESULTS: All 18 internal thoracic arteries were harvested successfully. Skeletonized internal thoracic artery harvests required more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvests (39.0 minutes +/- 1.4; p < 0.05). Internal thoracic artery flows during the final intervals were similar (skeletonized = 30.0 mL/min +/- 2.4 vs pedicle = 31.5 mL/min +/- 1.8; p = 0.9). Free internal thoracic artery bleeding flow was similar in both groups (skeletonized = 162.0 mL/min +/- 3.0 vs pedicle = 189.0 mL/min +/- 2.4; p = 0.4). Histologically, both groups were similar with minimal endothelial damage. CONCLUSIONS: Robotically skeletonized harvesting is safe, but it requires more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvesting. Despite muted tactile feedback with robotics, neither technique was associated with histologic or functional damage. These encouraging results may represent an advantage for complete arterial revascularization in robotic coronary bypass patients.

Animals↗
PubMed2000

Coronary bypass surgery using the internal thoracic artery after reconstruction of occluded subclavian artery.

We present two cases with an occluded left subclavian artery requiring coronary artery bypass grafting. A preoperative angiogram confirmed that the subclavian artery, including the internal thoracic artery distal from the occlusion, was thoroughly intact, in both cases. Immediately after reconstructing the subclavian artery using an aortoaxillary bypass with an 8 mm ring-reinforced polytetrafluoroethylene graft, each patient underwent double coronary artery bypass grafting using the affected left internal thoracic artery with either the right internal thoracic artery or a saphenous vein in the same anesthetic setting. Symptomatic relief was excellent. In both cases, a postoperative angiographic study showed good function of the left internal thoracic artery graft supplying blood to the coronary artery through the aortoaxillary bypass graft.

Aged↗
PubMed2003

Spontaneous recanalization of functionally occluded bilateral internal thoracic artery T graft.

Functional occlusion of the left internal thoracic artery T graft is reported. The patient underwent triple coronary artery bypass grafting with bilateral internal thoracic artery, anastomosing in situ to the left internal thoracic artery to the left anterior descending artery, free right internal thoracic artery to the obtuse marginal and posterolateral branch of the left circumflex artery. Early angiography showed occlusion of the in situ left internal thoracic artery to the moderately stenosed left anterior descending artery and patent side arm to circumflex. However, mid-term angiography revealed restoration of the left internal thoracic artery flow. A negative exercise stress test was noted throughout the postoperative period. Flow competition with a native coronary artery may be responsible for functional occlusion of the left internal thoracic artery.

Aged↗
PubMed1996

Coronary artery bypass grafting with both internal thoracic arteries and the right gastroepiploic artery.

From July 1989 to March 1995, 83 patients (79 men, 4 women, mean age 58.3 years, range 35 to 76 years) underwent coronary artery bypass grafting with the both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). Postoperative follow-up ranged from one to 69 months with a mean of 31 months. Seventy-eight patients (94%) had either triple vessel disease or left main disease. A total of 264 distal anastomoses with arterial grafts were constructed; 90 with the left ITA, 73 with the right ITA, 90 with the RGEA and 1 with the inferior epigastric artery (IEA). An additional saphenous vein graft was constructed in 13 patients including 4 sequential bypass grafting. The mean number of distal anastomoses was 3.4. Postoperative angiography was performed in 80 patients (96%) 3 to 4 weeks after the operation. There were no operative deaths or hospital deaths. No patients developed perioperative myocardial infarction. Graft patency in arterial grafts was 96% (242/253), 95% (80/84) in the left ITA, 100% (82/82) in the right ITA and IEA (1/1), and 93% (80/86) in the RGEA. Graft patency in vein grafts was 99% (84/85) and overall patency rate was 96% (326/338). Four patients (5%) died during follow-up period but all were non-cardiac deaths. Six postoperative percutaneous transluminal coronary angioplasties (PTCA) (7%) and two reoperations (re-CABG) (2%) were required, but no patients developed myocardial infarction (MI). The 5-year actuarial survival rate and cardiac event (cardiac death, MI, PTCA, and re-CABG) free rate was 90.1% and 86.6% respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with the both ITAs and RGEA was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.

Abdominal Muscles↗
PubMed1997

[Two cases of coronary artery bypass grafting following radical mastectomy using bilateral internal thoracic arterial grafts].

We report two cases of coronary artery bypass grafting following radical mastectomy using bilateral internal thoracic arterial grafts. One was a 68-year-old woman with angina pectoris, and the other was a 71-year-old woman with old myocardial infarction. Dissection of the internal thoracic arterial pedicles from the chest wall was not so difficult in both cases. The pedicles had good patency and each free flow of them was enough. They had no postoperative complications. It may be a useful method to use the internal thoracic arterial grafts for a case of coronary artery bypass grafting after radical mastectomy.

Aged↗
PubMed2002

Minimally invasive single-vessel coronary artery bypass with the internal thoracic artery and early postoperative angiography: midterm results of a prospective study in 120 consecutive patients.

BACKGROUND: This prospective study was undertaken to determine the role of the minimally invasive direct coronary artery bypass with early postoperative angiography and midterm follow-up in 120 consecutive patients with single-vessel coronary artery disease. METHODS: Minimal access (6 to 10 cm), without complete sternotomy and no cardiopulmonary bypass, was used. The lesions were located at the proximal left anterior descending coronary artery in 95% of the patients. Routine coronary angiography was performed before discharge. RESULTS: Postoperative angiography was performed in 104 (90.4%) of those 115 patients who had coronary revascularization concluded by the mini-access method. The internal thoracic artery patency rate was 98.1% (95.2% grade A). Two (1.7%) patients presented with perioperative myocardial infarction, which led to the single in-hospital death (0.8%). Of the remaining 119 patients, 113 (95.0%) were asymptomatic. The event-free probability was 94.9% and the actuarial survival was 98.3% with 42 months of follow-up. CONCLUSIONS: For selected patients with single-vessel coronary artery disease and no major myocardial dysfunction, minimally invasive direct coronary artery bypass is a safe operation and a less invasive alternative to conventional coronary artery bypass grafting.

Adult↗
PubMed2004

Midterm results of coronary artery bypass graft surgery with internal thoracic artery under low free-flow conditions.

BACKGROUND: We use the left internal thoracic artery (LITA) even when flow is very low. In this study, we investigated midterm outcome of coronary artery bypass graft surgery with low free-flow LITA. METHODS: One hundred patients undergoing coronary artery bypass graft surgery using LITA with a free flow of less than 20 mL/min were reviewed. The mean follow-up duration was 47.4 months, ranging from 1 to 65 months. Graft angiography was performed postoperatively. The diameter of the LITA was assessed angiographically. Cumulative graft patency, cardiac-related event-free rate, and actuarial survival rate were calculated by the Kaplan-Meier method. RESULTS: An early postoperative Doppler study showed that the diastolic-to-systolic ratio in the LITA was 1.76 +/- 0.33. A 1-month postoperative angiography revealed LITA string sign in 2 patients. One had a percutaneous coronary intervention, whereas string sign was not detected in the second patient, and LITA patency showed a marked improvement in 1-year postoperative angiogram. One month postoperatively the LITA diameter was 1.6 +/- 0.4 mm, and significantly enlarged in the second angiogram (1.9 +/- 0.4 mm, p = 0.0003). There was a significant correlation between the diameter of the LITA and the left anterior descending coronary artery (r = 0.889, p = 0.0001). The cumulative graft patency rate at 1 and 4 years was 99.0% and 94.3%, respectively. The cardiac-related event-free rate at 1 and 5 years was 97.0% and 93.3%, respectively. The actuarial survival rate at 5 years was 97.1%. CONCLUSIONS: Even with a very low LITA free flow, graft function improves with LITA growth, if there was no mechanical damage that impedes recovery.

Aged↗
PubMed1995

Internal thoracic artery grafts: 20-year clinical follow-up.

OBJECTIVES: This study compared the long-term clinical results of coronary artery bypass surgery in patients with internal thoracic artery grafts with those in patients with vein grafts only. BACKGROUND: Aortocoronary artery bypass surgery has been performed for > 25 years, primarily utilizing the saphenous vein and internal thoracic artery as conduits. Although the internal thoracic artery has been shown to confer a clinical advantage, it is not known for how many years this benefit will continue. METHODS: All consecutive patients undergoing initial coronary artery bypass surgery between 1970 and 1973 were followed for up to 20 years. Clinical evaluation included survival, late myocardial infarction, need for reoperation and recurrence of angina. Patients were analyzed in three groups: vein grafts only (214 patients); a single internal thoracic artery graft with or without associated vein grafts (490 patients); and bilateral internal thoracic artery grafts (39 patients). Use of the operating microscope was also analyzed with regard to effect on survival. RESULTS: The internal thoracic artery graft and use of the operating microscope were independent predictors of mortality and reduced the risk of dying by a factor of 0.68 and 0.76, respectively. An internal thoracic artery graft resulted in a mean survival of 4.4 years longer than that with vein grafts alone. The internal thoracic artery graft compared with vein grafts was associated with fewer reoperations (p < 0.001), fewer late myocardial infarctions, lower associated mortality rates (p < 0.04) and less early recurrence of angina (p = 0.03). CONCLUSIONS: The internal thoracic artery graft and use of the operating microscope confer a superior clinical advantage over the saphenous vein graft throughout a 20-year follow-up period. The advantage of an internal thoracic artery graft does not decrease with time, suggesting that the choice of conduit at the initial operation is more important clinically than progression of coronary artery disease.

Angina Pectoris↗
PubMed2006

Coronary artery bypass grafting using a bifurcated internal thoracic artery.

Coronary artery bypass grafting was performed successfully on a patient by anastomosing the left internal thoracic artery and its pericardiacophrenic branch to the obtuse marginal and the posterior descending coronary artery, respectively, to form a Y graft. Preoperative angiography of the internal thoracic artery had revealed the presence of an unusually large pericardiacophrenic branch almost the size of the main trunk, which allowed us to plan for bifurcated artery grafting.

Coronary Artery Bypass↗
PubMed1993

Internal thoracic artery: prevalence of atherosclerotic changes.

Use of the internal thoracic artery for myocardial revascularization has regained general acceptance because it offers better long-term results than do venous conduits. The aim of this study was to ascertain the prevalence of atherosclerosis in the internal thoracic artery and to correlate the prevalence with other known risk factors. A total of 117 patients (male/female ratio 84:33; mean age 56.8 years) were investigated. Sixty-eight patients had coronary artery disease, 25 had combined coronary artery and valvular heart disease, 14 had acquired valvular heart disease, and 10 had other types of heart disease. All but one patient underwent bilateral semiselective internal thoracic arteriography. Evidence of atherosclerotic change was present in 6.6% of the opacified vessels in 11.1% of the investigated individuals. Although all patients with atherosclerotic lesions in the internal thoracic artery had coronary artery disease, no correlation could be found between coronary artery disease and internal thoracic atherosclerosis. Peripheral vascular disease and hyperlipidemia could be identified as predictors of atherosclerotic changes in the internal thoracic artery. Atherosclerosis is somewhat more prevalent in the internal thoracic artery in this study than in the literature. Although the internal thoracic artery is a protected vessel, there is a certain extent of atherosclerosis, that correlates with known risk factors. Our observations should not preclude use of the internal thoracic artery, but they should be considered for patients who are at risk for atherosclerotic changes of the internal thoracic artery.

Adult↗
PubMedDate not supplied

An evidence-based review of magnetic resonance angiography for diagnosing arterial thoracic outlet syndrome.

Arterial thoracic outlet syndrome (TOS) can be difficult to diagnose clinically. Recently, Magnetic Resonance Angiography (MRA) has been used to assist in the diagnosis of arterial TOS. The purpose of this article is to survey the current literature to establish the evidence for or against the use of MRA in the diagnosis of arterial TOS. The evidence-based search was conducted using PubMed, PEDro, Hooked on Evidence, EBM Journals, Ovid, Cochrane, and E medicine. The studies were graded as to the strength of recommendation and to the actual level of evidence. Statistics were calculated when sufficient data were present. The search yielded a total of seven studies. The studies received grades of recommendation that ranged from B to D. The current evidence in support of MRA as a valid test for diagnosing arterial TOS is weak and studies are not based on strong design.

Evidence-Based Medicine↗
PubMed2004

The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years.

BACKGROUND: To compare survival of patients receiving bilateral internal thoracic artery grafts and single internal thoracic artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. METHODS: From cohorts of 8123 patients receiving single internal thoracic artery grafts and 2001 receiving bilateral internal thoracic artery grafts during primary isolated bypass operations for multivessel coronary disease between 1971 and 1989, we identified 1152 propensity-matched pairs. Mean follow-up of survivors was 16.5 years, with 51 patients followed for 20 years or more. Hazard function methodology was used to identify risk factors for mortality, compare survival, and assess magnitude of benefit. RESULTS: Comparison of the matched pairs showed survival of the bilateral internal thoracic artery and single internal thoracic artery groups at 7, 10, 15, and 20 years was 89% versus 87%, 81% versus 78%, 67% versus 58%, and 50% versus 37%, respectively (p < 0.0001). Divergence of bilateral internal thoracic artery and single internal thoracic artery hazard function curves continued to widen through 20 postoperative years. At 20 years, bilateral internal thoracic artery grafting was predicted to produce worse survival in 2.8% of patients, a survival advantage of less than 5% in 12.9%, greater than 10% in 52%, and greater than 15% in 7.6%. Combinations of cardiac and noncardiac descriptors were used to define higher and lower risk patient subsets. Advanced age, abnormal left ventricular function and noncardiac risk factors decreased overall survival but the incremental benefit of bilateral internal thoracic artery grafting persisted. CONCLUSIONS: Bilateral internal thoracic artery grafting produces improved survival compared with single internal thoracic artery grafting during the second postoperative decade, and the magnitude of that benefit increases through 20 postoperative years.

Coronary Disease↗
PubMed1998

[A case of coronary artery bypass surgery using left internal thoracic artery and right gastroepiploic artery for a patient with essential thrombocythemia].

The 78-year-old male underwent coronary angiography because of angina pectoris. He was revealed to have essential thrombocythemia with a platelet count of over 1,000,000/mm3. Essential thrombocythemia belongs to the group of chronic myeloproliferative disorders. It displays both thrombogenic and bleeding tendency due to the increased platelet count, as well as to dysfunction. CABG was performed using the left internal thoracic artery and the right gastroepiploic artery. Hydroxycarbamide was taken to regulate the platelet count before surgery. There was no difficulty with hemostasis during surgery. Warfarin and hydroxycarbamide were used as anticoagulant therapies after surgery. Postoperative CAG demonstrated both grafts to be patients. The patient remained in good condition until he died suddenly on the 159th postoperative day. The cause of death was not clear because no autopsy was carried out. The death may have been associated with a thromboembolism, acute graft thrombosis or cerebral infarction, or pulmonary embolism. This patient did not take antiplatelet drugs because the platelet count and prothrombin time was well controlled. Nonetheless, an antiplatelet agent might reduce the risk of thromboembolism in such patients. It is suggested that meticulous anticoagulation therapy must be important for a patient with essential thrombocythemia, especially in the postoperative period.

Aged↗
PubMed1991

Comparative anatomy and histology of the radial artery and the internal thoracic artery. Implication for coronary artery bypass.

Anatomical characteristics of the radial a. were compared to those of the internal thoracic a., considered as a gold standard in coronary surgery. The length, the diameter, the collateral distribution and the wall thickness of these two arteries were studied comparatively. In addition, a comparative histological analysis was carried out. Anatomical and histological characteristics of these two arteries have important implications for coronary artery bypass.

Angiography↗
PubMed2004

Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery.

OBJECTIVE: In order to reduce remote cardiac events associated with graft occlusions, arterial conduits are being increasingly utilized in coronary artery bypass grafting (CABG). While the internal thoracic artery (ITA) is the graft of choice for CABG, it is sometimes difficult or impossible to obtain a complete arterial revascularization only with ITAs in three-vessel diseases. We present our experience with total arterial myocardial revascularization with bilateral internal thoracic artery (BITA) and right gastroepiploic artery (rGEA). METHODS: From April 1994 to January 2004, 174 patients (165 male, mean age 55.9+/-7.4) underwent coronary artery bypass procedure with exclusive use of BITA and rGEA. Left ventricular ejection fraction ranged from 20 to 68% (mean 55.9+/-6.8%). Seven patients (4%) had poor ejection fraction (<0.30), 23 (13, 2%) had acute myocardial infarction, 14 (8%) had left main disease. The mean CPB time was 96.9+/-15.7 min and the mean cross clamping time was 70+/-14.2 min. The mean number of distal anastomoses was 3.3+/-0.5 per patient. RESULTS: Early mortality was 1.7%. The patients were followed for up to 9 years (mean follow-up time 6.3+/-2.6 years). Actuarial freedom from cardiac death (including hospital death) was 97.6%, at 9 years after the operation. Actuarial freedom from angina and cardiac events at 9 years was 79, 5% and 77, 6%, respectively. No perioperative myocardial infarction occurred. None of the patients needed a redo-CABG after leaving the hospital. CONCLUSIONS: This study indicates that the myocardial revascularization in young patients with three-vessel disease using exclusively pedicle BITA and rGEA provides excellent 9-year patient survival and improvement in terms of freedom from return of angina pectoris and freedom from any cardiac-related event. These results encourage the more extensive use of BITA and rGEA in selected patients with three-vessel coronary disease.

Angina Pectoris↗