To skeletonize the internal thoracic artery or not? Is that the question?

The internal thoracic artery (ITA) is the preferred conduit for surgical coronary artery revascularization because of superior long-term patency rates and observational evidence of improved long-term outcomes. It is usually harvested with a pedicle of surrounding tissue, presumably not to disrupt its viability and blood supply. Resultant hypoperfusion of the sternum and an increased rate of sternal wound infections, particularly when bilateral ITAs are used, have prompted certain surgeons to harvest the ITA in a skeletonized fashion, ie, without its surrounding tissue. Stripping the ITA from its surrounding tissues interrupts its nerve and blood supply and may hypothetically interfere with its function and reactivity. However, studies that have addressed this issue, including 2 randomized studies by Gaudino and his group,1,2 have provided convincing evidence that the integrity and reactivity of the skeletonized and pedicled ITA are similar.