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| Name | How to harvest the left internal mammary artery (LIMA): Part 2 |
| Video Uploader | Video From SBK (SBK) |
| Upload Date | This Video Uploaded At 24-02-2020 15:09:05 |
| Video Discription | The left internal mammary artery (LIMA) is the gold standard conduit for myocardial revascularization because of its widely reported clinical and survival benefits when compared with saphenous vein grafts. The use of LIMA grafts increases survival and reduces the incidence of recurrent angina, late myocardial infarction, and repeat coronary intervention. How to harvest: Techniques 1 Pedicled Conduit with fascia, muscle and fat Only conduit with accompanying veins 2 Pedicled but divided distally to start with (Hanging technique) With fascia, muscle and fat Without fascia, muscle and fat Clip Clip Cut : what is it?? Less tissue trauma, less postop drainage or bleeding Good and undamaged conduit Less postoperative complication Preserves collateral connections Avoid thermal injury to the IMA Anatomy of the IMA: Sternal perfusion derives from the IMA, and its harvesting is thought to result in sternal devascularization. Branches that arise from the anterior aspect of the IMAare the anterior intercostal, sternal, and perforating arteries, the latter two forming the main supply to the sternum, the periosteal vascular plexi (superficial and deep, respectively). The anterior intercostal branches anastomose with the posterior intercostal arteries (arising from the descending thoracic aorta), and the perforating branches anastomose with the lateral thoracic and thoracoacromial arteries. These branches originate either together as common trunks or independently . Consequently, preservation of these trunks during harvest, by ligation of branches as close to the IMA as possible, may improve collateral sternal blood supply. References: DOI:https://doi.org/10.1016/S0003-4975(96)00529-2 VOLUME 62, ISSUE 3, P908-909, AUGUST 01, 1996 https://mmcts.org/tutorial/611 Ann Thorac Surg 2015;100:1942–53 My credentials: Facebook : https://www.facebook.com/The-Heart-Surgery-Factory-102326067972600/ Youtube : https://www.youtube.com/channel/UCAXvuk2YTOKcCUzCr2QatpA Gmail: [email protected] Twitter: @theheartsurgeon |
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