Should the diabetics have the internal thoracic artery skeletonized? Assessment of sternal perfusion by scintillography

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 diabetic population, seven in each group, there was a marked 47.4% higher perfusion of the sternum in Group A patients (skeletonized ITA) comparing to Group B (pedicled ITA) and this difference reached statistical significance (P = 0.004). 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.