The takedown of the Internal Thoracic Artery (ITA) represents the cornerstone of surgical revascularization. The ITA is employed in almost all patients to graft the left anterior descending (LAD) artery. In general, this conduit is harvested as a pedicle along with the endothoracic fascia, satellites veins, and surrounding tissues. An alternative approach is to harvest the ITA alone, a method known as skeletonization. This approach may result in less trauma of the chest wall, longer mammaries, and possibly the ability to perform sequential grafts. However, it can also be tedious, leading to longer operative times and increased ITA trauma. 

The technique presented in this video involves harvesting the ITA with one of its two satellite veins while respecting the fascia and avoiding a large pedicle. This method is fast, easy to learn, and associated with few complications. The authors have used this technique for more than 20 years with excellent results. This video showcases several important tricks to achieve a long and well-functioning ITA. 

References

1. Horii T, Suma H. Semiskeletonization of internal thoracic artery: alternative harvest technique. Ann Thorac Surg. 1997;63:867-8.
2. Rescigno G, Uva MS, Lessana A. Semiskeletonized internal thoracic artery. Ann Thorac Surg. 1997;64:1869.

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