Effect of skeletonization of the internal thoracic artery on vessel wall integrity

Background. This study was conceived to evaluate the effect of internal thoracic artery (ITA) skeletonization on vessel wall integrity. Methods. Forty consecutive patients undergoing coronary artery bypass were randomized to receive a skeletonized (n = 22) or a pedicled (n = 18) ITA graft. ITA harvesting was performed by 2 experienced surgeons using the same instrumentation and technique. Specimens were examined by light and electron microscope in order to assess vascular wall integrity. A specific immunohistochemical staining and a computerized method were used to quantify the degree of endothelial integrity after surgical preparation. Results. Morphologic analysis revealed 2 cases of limited subadventitial hemorrhage (one for each group) and no case of major arterial damage. Immunohistochemical staining demonstrated an extremely high degree of maintenance of the endothelial integrity in both groups (97.2% ± 1.9% in the skeletonized and 96.8% ± 2.1% in the pedicled one; p = 0.53). Conclusions. Skeletonization does not affect ITA wall integrity in humans submitted to coronary artery bypass procedures.