How are internal thoracic (mammary) arteries harvested for coronary artery bypass grafting (CABG)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The left internal thoracic (mammary) artery (LITA) and the right internal thoracic (mammary) artery (RITA) arise from their respective subclavian arteries. The internal thoracic (mammary) artery can be harvested either by itself or as a pedicle (see the figure below).

Illustration of an internal thoracic (mammary) art Illustration of an internal thoracic (mammary) artery (IMA) harvest as a pedicle.

 

Whereas the LITA is most commonly harvested as a pedicle, the RITA is generally skeletonized, because an RITA pedicle may interfere with sternal wound healing. The LITA is useful in left anterior descending (LAD) artery anastomosis and has a good patency rate in this setting (98% at 1 year and 90% at 10 years). The RITA has a good patency rate when anastomosed to the LAD (96% at 1 year and 90% at 5 years) but a reduced rate when grafted to the circumflex or the right coronary artery (75% at 1 year).


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