Technical aspects of double-skeletonized internal mammary artery grafting Jacob Gurevitch, MD, Amir Kramer, MD, Chaim Locker, MD, Itzhak Shapira, MD,

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Presentation transcript:

Technical aspects of double-skeletonized internal mammary artery grafting Jacob Gurevitch, MD, Amir Kramer, MD, Chaim Locker, MD, Itzhak Shapira, MD, Yosef Paz, MD, Menachem Matsa, MD, Rephael Mohr, MD The Annals of Thoracic Surgery Volume 69, Issue 3, Pages 841-846 (March 2000) DOI: 10.1016/S0003-4975(99)01407-1

Fig 1 (A) The pedicled internal mammary artery (IMA) (A), the skeletonized IMA (B), and skeletonized IMA embedded in papaverine solution (jacuzzi) (C). (B) The left skeletonized IMA during harvesting. (C) The skeletonized IMA after harvesting inside a jacuzzi. The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)

Fig 1 (A) The pedicled internal mammary artery (IMA) (A), the skeletonized IMA (B), and skeletonized IMA embedded in papaverine solution (jacuzzi) (C). (B) The left skeletonized IMA during harvesting. (C) The skeletonized IMA after harvesting inside a jacuzzi. The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)

Fig 1 (A) The pedicled internal mammary artery (IMA) (A), the skeletonized IMA (B), and skeletonized IMA embedded in papaverine solution (jacuzzi) (C). (B) The left skeletonized IMA during harvesting. (C) The skeletonized IMA after harvesting inside a jacuzzi. The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)

Fig 2 Collateral blood flow to the sternum is preserved after division of internal mammary artery side branches. The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)

Fig 3 (A) The cross arrangement: left internal mammary artery (LIMA) anastomoses the first marginal circumflex coronary artery, right internal mammary artery (RIMA) anastomoses the left anterior descending coronary artery (LAD), and the right gastroepiploic artery to the right posterior descending coronary artery. (B) The composite arrangement: in situ LIMA to LAD, and free RIMA (proximally attached end-to-side to LIMA) to first and the second circumflex marginals. The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)

Fig 4 The composite T-shape anastomosis was preformed here before cardiopulmonary bypass. Free right internal mammary artery was attached to in situ left internal mammary artery (A = scheme, B = photograph). The Annals of Thoracic Surgery 2000 69, 841-846DOI: (10.1016/S0003-4975(99)01407-1)