Internal thoracic vein: friend or foe?

The internal thoracic vein is a conduit that has not been thoroughly investigated in literature as long term patency and outcomes are unknown. We present a case where the right internal thoracic vein (RITV) was used to extend a short right internal thoracic artery (RITA). The elongated composite conduit was then anastomosed to the right coronary artery (RCA). A 61-year-old male patient was referred electively for a coronary artery bypass grafting (CABG) operation. The patient had undergone extensive stenting to the left and right coronary artery systems. Unfortunately the stents to the right coronary artery had restenosed causing significant symptoms necessitating revascularization (Figure 1). From the conduit point of view, the patient had his long saphenous veins fully stripped bilaterally. His radial arteries were assessed with Allen’s test and use of saturation monitor: following the occlusion of the radial the saturations failed to rise, therefore they were deemed unusable. RITA was therefore elected to be the conduit of choice. The operation was performed in a standard on-pump fashion. RITA was harvested initially as a pedicled graft. The target vessel was measuring approximately 1.5 mm in diameter and was opened distally due to the presence of the previous stents and the anatomy of the lesions. Unfortunately RITA intima was found to be of suboptimal quality and calibre distally and had to be shortened. This resulted in RITA length being insufficient to reach the target vessel, even with skeletonisation. RITA was then extended with a 2-3 cm segment of RITV which appeared to be of good quality and calibre. The reversed RITV and RITA were anastomosed in an end-to-end fashion using continuous 8-0 polypropylene suture (Figure 2). The composite graft was then anastomosed