Skeletonization of LIMA: Angiographic correlates of graft patency and 5-years outcome

Abstract

Background: The skeletonized harvesting is thought to be more traumatic for the conduit, and it is conceivably possible that it could damage to the Left Internal Mammary Artery (LIMA) innervations. Although the survival advantage of LIMAs compared with other grafts is accepted worldwide, no clear benefit of one harvesting technique over the other have been definitely demonstrated. Moreover, little is known about the in-vivo functional behaviour of skeletonized grafts.

Methods: We studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery (LAD). In 30 consecutive LIMAs were harvested as a pedicle (Group P) and another 30 consecutive LIMAs were harvested as skeletonized graft (Group S). LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting. Clinical follow up and out come analysis of 5 years result.

Results: Check coronary angiography showed the LIMA grafts to the LAD were all patent. Only 1 in 30 (3.33%) patient of pedicle group showed a string sign. Though complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001) but significantly less time required for harvesting in pedicle group. There was similar incidence of superficial wound complications and PCP in both groups. There was no significant difference in diameter throughout the graft length except for increased diameter achievement in skeletonized group at anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). 5 years clinical outcome were not significant among the groups.

Conclusion: We conclude that skeletonized and pedicled LIMA showed a similar functional behavior, giving similar in-hospital results, similar post-operative profile and similar postoperative angiographic profile and 5-year outcome. Apart from the need for longer conduits, there is no reason to prefer skeletonized to pedicle mammary grafts.