Diabéticos devem ter a artéria torácica interna esqueletizada? Avaliação da perfusão esternal por cintilografia

Abstract

Objective: To assess, by scintillography, the effect of using bilateral internal thoracic arteries (BITAs) -prepared by two different techniques -on the sternal perfusion.Method: 35 patients undergone coronary artery bypass grafting (CABG) were divided into two groups: Group A (18) had both ITA's dissected using skeletonization technique and group B (17) as pedicle preparation. There was no difference in the two groups relating gender, age and demographic characteristics. On the 7 th postoperative day the patients underwent bone scintillography. The statistical analysis was performed using the Student's t test with 95% significance.Results: Group A (skeletonized ITA) showed higher perfusion (11.5%) of the sternum as a mean, than Group B (pedicled ITA) patients; however this was not statistically significant (P = 0.127). On the other hand, comparing the 004).Conclusions: 1 -Sternal perfusion is not affected significantly apart from the dissection technique used for both internal thoracic arteries in the general population when assessed by bone scintillography. 2 -In the diabetic subgroup, a significant preservation of the sternal perfusion was observed in patients undergone skeletonized dissection of the internal thoracic arteries. Although these findings should be confirmed in a greater number of cases, diabetic patients should have the internal thoracic arteries dissected using skeletonization techinque.Descriptors: Sternum. Mammary arteries. Tomography, emission-computed. 158SANTOS FILHO, EC ET AL -Should the diabetics have the internal thoracic artery skeletonized? Assessment of sternal perfusion by scintillography Bras Cir Cardiovasc 2009; 24(2): 157-164 Rev

Incidence of Deep Sternal Wound Infection in Diabetic Patients Undergoing Off-Pump Skeletonized Internal Thoracic Artery Grafting

“…There are very few reports on low early mortality rates and good long-term outcomes with routine use of pedicled bilateral ITA grafts for left-sided myocardial revascularization in insulin-dependent diabetics [21], and it is commonly perceived that pedicled bilateral ITA grafts should not be performed in diabetic patients due to an increased risk of DSWI, leading to mediastinitis, septicemia, and even death [8,9,10,11]. Skeletonization was associated with a high residual sternal blood supply and a reduction in sternal ischemia, subsequently lowering the risk of deep sternal wound complications [12,13,14,15,22,23]. However, few reports have focused on evaluation of the risk of DSWI in diabetic patients undergoing off-pump skeletonized bilateral or single ITA grafting compared to off-pump pedicled ITA grafting.…”

“…A skeletonized ITA graft compared to a pedicled ITA graft preserves collateral circulation to the sternum and drainage of the internal mammary veins, which reduces the risk of DSWI after CABG surgery. Skeletonized bilateral ITA grafting has been proposed as a possible approach to reduce the incidence of sternal infection while maintaining the benefits of the application of bilateral ITA grafts [12,13,14,15]. However, few reports have focused on evaluation of the merit of skeletonized bilateral or single ITA grafting compared to pedicled ITA grafting in reducing the risk of DSWI in diabetic patients undergoing off-pump CABG (OPCAB) surgery.…”

Pathological study of sternal osteomyelitis after median thoracotomy—a prospective cohort study

“…Using bone scintigraphy, Korbmacher et al found no perfusion impairment on the LIMA side, although the contralateral side showed an increase in perfusion as a compensatory sign. A similar study in patients with BIMA showed a significant drop in sternal perfusion only in the diabetic subgroup [ 16 ], which could be explained by the missing redistribution of circulation in patients with microangiopathy. All this data points to the idea that the development of SO is a multifactorial process, where contamination, blood supply, and comorbidities play a collective role in the pathogenesis.…”