Currie Maria E, Fox Stephanie A, Greer-Bayramoglu Rebecca J, Fortin Amanda J, Chu Michael W A
Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, London, ON, Canada.
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):811-5. doi: 10.1093/icvts/ivs366. Epub 2012 Aug 16.
Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG).
Anatomic analysis of 20 female patients undergoing CABG was performed examining internal thoracic artery length from its origin to the third, fourth, fifth intercostal spaces and the left anterior descending (LAD) artery target.
The left internal thoracic artery was anastamosed to the LAD target at a mean length of 11.4 ± 1.4 cm. The mean lengths of the pedicled left internal thoracic artery from its origin to the third, fourth and fifth intercostal space were 8.5 ± 1.0, 10.9 ± 1.2 and 13.0 ± 1.4 cm, respectively. Therefore, the left internal thoracic artery length was adequate at the fourth intercostal space in 6 of 20 (30%) patients.
Dissection of the left internal thoracic artery to the fourth intercostal space would allow for concomitant use in CABG and breast reconstruction in one-third of cases. However, skeletonization of the internal thoracic artery at the level of the fourth intercostal space would be sufficient for CABG in all cases following autologous breast reconstruction.
最近，胸廓内动脉已优先用于第三或第四肋间水平的自体乳房重建。这可能会影响未来对隐匿性冠心病的治疗。我们推测，第四肋间水平的胸廓内动脉长度既能满足乳房重建，又能满足未来冠状动脉旁路移植术（CABG）的需求。
对20例行CABG的女性患者进行解剖分析，检查胸廓内动脉从其起点到第三、第四、第五肋间以及左前降支（LAD）动脉靶点的长度。
左胸廓内动脉与LAD靶点吻合的平均长度为11.4±1.4cm。带蒂左胸廓内动脉从其起点到第三、第四和第五肋间的平均长度分别为8.5±1.0cm、10.9±1.2cm和13.0±1.4cm。因此，20例患者中有6例（30%）在第四肋间水平的左胸廓内动脉长度足够。
将左胸廓内动脉解剖至第四肋间水平，在三分之一的病例中可同时用于CABG和乳房重建。然而，在自体乳房重建后的所有病例中，第四肋间水平的胸廓内动脉骨骼化足以用于CABG。
