Effects of Skeletonized versus Pedicled Internal Thoracic Artery Grafts on Free Flow Capacity during Bypass

The free flow of skeletonized ITA grafts was compared with that of pedicled ITA grafts. One hundred patients with coronary artery diseases underwent elective CABG. In the group Ⅰ(n= 50), the left ITA was dissected using the skeletonization technique. In the group Ⅱ(n=50), the ITA was harvested as a pedicled graft. Free flow of the ITA was recorded before and 15 min after in- traluminal application of diluted papaverine. Mean arterial pressure was maintained at 9. 31 kPa (70 mmHg). The results showed that before the application of papaverine, free flow of skeletonized and pedicled ITA grafts was identical between the two groups. After treatment with papaverine, the maximum free flow was significantly higher in the skeletonized ITA's in the group Ⅰ(199. 3±69. 6 ml/min) than in the group Ⅱ(145. 7±70. 3 ml/min, P<0. 05). There was on significant differ- ence between the free flow after dilatation of the left and right ITA in the group Ⅰ (left 199. 3±69. 6 ml/mm, right 198. 9±61. 8 ml/mm, respectively). It was concluded that preparation of the ITA with the skeletonization technique resulted in significantly higher free flow capacity than in pedicled grafts and would improve the results of arterial revascularization. The complication rate seems to be lower than with the conventional method.

Common trunk of the right accessory renal artery and right inferior phrenic artery originating from the thoracic artery:An unreported variation

Accessory renal arteries(ARAs)are common and usually originate from the abdominal aorta and the renal artery.Inferior phrenic arteries(IPAs)can also arise from the abdominal aorta or its branches.In this paper,we present the first case of a common trunk of the right ARA and right IPA arising from the thoracic artery at the level of T10,which was discovered by multidetector-row computed tomography in pretherapeutic evaluation and clearly confirmed by selective angiography.It is important to recognize this anatomical variation when performing cardiovascular and interventional radiological procedures.

Awake off-pump coronary artery bypass surgery in 25 patients

Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia

Efficacy and safety of transcatheter chemoembolization of the internal thoracic artery in patients with hepatocellular carcinoma

Background Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization （TACE）in patients with hepatocellular carcinoma （HCC）. We evaluated the efficacy and safety of TACE, and the prevention and management of complications among patients in whom the internal thoracic artery （ITA） was involved.Methods A total of 3614 cases of HCC were treated with 12 645 TACEs and 211 of these cases were given ITA angiography, including 156 cases of which the ITA was involved. We performed 562 TACEs in the 156 cases. We analyzed imaging examinations, types of embolization, and the incidence, prevention, and treatment of complications.Results The ITA was successfully embolized in 156 cases. Angiography of the ITA showed that the major trunks were thickened with an increased number of branching vessels, contributing to intrahepatic and extrahepatic tumor blood supply. Different embolization methods were selected according to the blood supply, to effectively embolize the tumor and mitigate or avoid serious complications. TACE with ITA embolization extended the mean interval time between two treatments from 2.54 months （1-17 months） to 4.23 months （1-30 months） compared with that without ITA embolization.The ITA supplied the HCC in the following instances： HCC was located in the ventral hepatic area and abutted the diaphragm （P=0.0064） and repeated TACE （P=0.0003）. The survival rate of TACE with ITA embolization for HCC was better than TACE without ITA embolization （P ＜0.00001 ）.Conclusions In cases with massive HCC or nodular HCC, the ITA may be involved in supplying blood to the tumor.This occurs when the tumor is positioned in the ventral hepatic area and abuts the diaphragm （S2, S4, and S8）, and especially if cases have a previous history of TACE. In this case series, embolization was effective, extended the mean interval time of interventional therapy, and prolonged survival time.

Robotic internal thoracic artery harvesting： the learning curve and graft patency

Since the first report of totally endoscopic coronary artery bypass graft （CABG） using da Vinci SurgicalSystem （Intuitive Surgical, Sunnyvale, CA, USA） in 1999, the robotic technology has been applied to internal thoracic artery （ITA） harvesting for more than I0 years. We present the experience of robotic ITA skeletonized harvesting in 200 cases using the da Vinci S or da Vinci SI Surgical System. The learning curves of 1TA harvesting time and the results of ITA graft patency were evaluated.

A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery （ITA） grafting and Cooley＇s technique.

Twenty years of experience with the rabbit model,a versatile model for tracheal transplantation research

Pathologies comprising more than half the length of the trachea are a challenge to the reconstructive surgeon.Innovative tracheal transplantation techniques aim to offer the patient a curative solution with a sustained improvement in quality of life.This review summarizes the authors’experience with the rabbit as a versatile model for research regarding tracheal transplantation.Because of the segmental blood supply of the trachea,it is not feasible to transplant the organ together with a well-defined vascular pedicle.As such,the key element of successful tracheal transplantation is the creation of a new blood supply.This vascularized construct is created by prelaminating the rabbit trachea heterotopically,within the lateral thoracic fascia.After prelamination,the construct and its vascular pedicle are transferred to the orthotopic position in the neck.This model has become gold standard because of the advantages of working with rabbits,the anatomy of the rabbit trachea,and the reliability of the lateral thoracic artery flap.In this paper,the key elements of surgery in the rabbit are discussed,as well as the tracheal anastomosis and the harvest of the lateral thoracic artery flap.Practical tips and tricks are presented.The data described in this review represent the fundaments of ongoing translational research in the center over the past twenty years.