Department of Surgery, St. Louis University School of Medicine, Surgical Service, Veterans Affairs Medical Center, St. Louis, Missouri 63110, USA.
Ann Thorac Surg. 2011 Jan;91(1):38-41. doi: 10.1016/j.athoracsur.2010.08.060.
The internal thoracic artery (ITA) and inferior epigastric artery (IEA) may be used as conduits for myocardial revascularization. Harvesting the ITAs and IEAs can lead to clinically significant ischemia of the anterior abdominal wall.
We created a registry with data from 108 patients receiving myocardial revascularization with 1 or greater ITA and (or) 1 or greater IEA. After revascularization, patients were followed to document their outcomes during hospitalization. We sought to identify risk factors for tissue necrosis in these patients.
All patients had 1 (84%) or 2 (16%) IEAs harvested. Both ITAs were utilized in 81% of patients; 19% had only the left ITA harvested. All patients in whom 2 IEAs were harvested also had 2 ITAs harvested (17 of 108). Of these 17 patients, 2 (12%) developed abdominal wall necrosis. Only patients who had bilateral ITA and bilateral IEA harvest experienced this complication.
Bilateral harvest of ITAs and IEAs results in a moderate risk of clinically significant abdominal wall necrosis. The extent of tissue loss may involve skin, muscle, and fascia, but the peritoneum and posterior rectus sheath remained intact in both affected patients in this series. These data may be most valuable to those who contemplate an abdominal operation in a patient who has had one or more of their ITAs or IEAs taken.
内乳动脉（ITA）和腹壁下动脉（IEA）可作为心肌血运重建的血管。采集 ITA 和 IEA 会导致前腹壁出现明显的缺血。
我们创建了一个注册中心，其中包含 108 名接受心肌血运重建的患者的数据，这些患者至少使用了 1 支 ITA 和（或）1 支以上的 IEA。血运重建后，对患者进行随访，以记录其住院期间的结局。我们试图确定这些患者发生组织坏死的风险因素。
所有患者均采集了 1 支（84%）或 2 支（16%）IEA。81%的患者使用了双侧 ITA；19%的患者仅采集了左侧 ITA。所有采集了 2 支 IEA 的患者也采集了双侧 ITA（108 例中的 17 例）。这 17 例患者中，有 2 例（12%）发生了腹壁坏死。只有双侧采集 ITA 和 IEA 的患者才会出现这种并发症。
双侧采集 ITA 和 IEA 会导致中度的腹壁缺血性坏死风险。组织损失的程度可能涉及皮肤、肌肉和筋膜，但在本系列中，所有受影响的患者的腹膜和后直肌鞘均保持完整。对于那些考虑在已经接受 ITA 或 IEA 采集的患者中进行腹部手术的人来说，这些数据可能最有价值。
