Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

Aim of the Study: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conduc...

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Autores principales:	Syed Raza Shah, Syed Arbab Shah, Muhammad Ahmed Jangda, Mohammad Danial Yaqub, Ayesha Altaf Jangda, Maham Khan, Muhammad Asim Khan, Brian Tomkins
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2017
Materias:	Internal mammary artery pedicled skeletonized topical vasodilator Medicine R
Acceso en línea:	https://doaj.org/article/0f7b237431c645fa84985ebb58883014
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spelling	oai:doaj.org-article:0f7b237431c645fa84985ebb588830142021-12-02T02:53:00ZTopical vasodilator response in skeletonized internal mammary artery: Is there really a difference?2231-077010.4103/2231-0770.197510https://doaj.org/article/0f7b237431c645fa84985ebb588830142017-01-01T00:00:00Zhttp://www.avicennajmed.com/article.asp?issn=2231-0770;year=2017;volume=7;issue=1;spage=23;epage=27;aulast=Shahhttps://doaj.org/toc/2231-0770Aim of the Study: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after the application of topical vasodilator in skeletonized and pedicled IMA. Materials and Methods: In this study, each patient underwent either skeletonized (n = 25) or pedicled IMA harvesting (n = 25). The type of graft on each individual patient was decided randomly. Intraoperative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions, before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study. Results: The blood flow before the application of topical vasodilator was similar in both the groups (P = 0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001). Conclusion: Our study signifies that skeletonization of IMA results in increased graft length and blood flow after the application of topical vasodilator. However, we recommend that long-term clinical trials should be conducted to fully determine long-term patency rates of skeletonized IMA.Syed Raza ShahSyed Arbab ShahMuhammad Ahmed JangdaMohammad Danial YaqubAyesha Altaf JangdaMaham KhanMuhammad Asim KhanBrian TomkinsThieme Medical and Scientific Publishers Pvt. Ltd.articleInternal mammary arterypedicledskeletonizedtopical vasodilatorMedicineRENAvicenna Journal of Medicine, Vol 7, Iss 1, Pp 23-27 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Internal mammary artery pedicled skeletonized topical vasodilator Medicine R
spellingShingle	Internal mammary artery pedicled skeletonized topical vasodilator Medicine R Syed Raza Shah Syed Arbab Shah Muhammad Ahmed Jangda Mohammad Danial Yaqub Ayesha Altaf Jangda Maham Khan Muhammad Asim Khan Brian Tomkins Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
description	Aim of the Study: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after the application of topical vasodilator in skeletonized and pedicled IMA. Materials and Methods: In this study, each patient underwent either skeletonized (n = 25) or pedicled IMA harvesting (n = 25). The type of graft on each individual patient was decided randomly. Intraoperative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions, before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study. Results: The blood flow before the application of topical vasodilator was similar in both the groups (P = 0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001). Conclusion: Our study signifies that skeletonization of IMA results in increased graft length and blood flow after the application of topical vasodilator. However, we recommend that long-term clinical trials should be conducted to fully determine long-term patency rates of skeletonized IMA.
format	article
author	Syed Raza Shah Syed Arbab Shah Muhammad Ahmed Jangda Mohammad Danial Yaqub Ayesha Altaf Jangda Maham Khan Muhammad Asim Khan Brian Tomkins
author_facet	Syed Raza Shah Syed Arbab Shah Muhammad Ahmed Jangda Mohammad Danial Yaqub Ayesha Altaf Jangda Maham Khan Muhammad Asim Khan Brian Tomkins
author_sort	Syed Raza Shah
title	Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
title_short	Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
title_full	Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
title_fullStr	Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
title_full_unstemmed	Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?
title_sort	topical vasodilator response in skeletonized internal mammary artery: is there really a difference?
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2017
url	https://doaj.org/article/0f7b237431c645fa84985ebb58883014
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Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

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