الفهرس 
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Abstract
CABG is the most commonly performed heart operation. CABG has demonstrated superior long-term survival compared with percutaneous therapy for diabetic patients with multi-vessel disease.
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.
It is now well established that more than 95 % of CABG patients, currently receiving a SIMA graft with excellent long-term patency relative to vein grafts, which is now known to continue into the second and third decade of follow-up. This better outcome is mainly due to better long-term patency of a SIMA graft to vein grafts where, due to atherosclerosis, around half are occluded and half of the remainders are severely diseased.
The better clinical outcome associated with arterial graft encouraged many studies about the use of BIMA with reports of even better clinical outcomes. Superior patency of BIMA grafts compared with vein grafts, confirmed by angiography, with patency rates of BIMA grafts being as high as 98% at 7 days and 95% at 2 and 7 years.
While BIMA grafting offers superior revascularization, it is technically more challenging, and concerns that it is associated with longer operating time with increased risk of early mortality and major morbidity, especially impaired wound healing, have prevented widespread use compared to SIMA grafting. Thus only used in 10% of CABG cases in Europe and 4% in USA.
The skeletonization technique, first described by Keeley in 1987, involves harvesting IMA with no surrounding tissue, while traditional IMA harvesting technique involves the dissection of a rim of tissue (1 to 2 cm) around the IMA. Skeletonization of the IMA has been proposed as a solution to many of the problems associated with IMA harvesting.
Although theoretically there is higher risk of injury with dissection in skeletonized IMA, studies show no differences in microscopic injury or vascular function when skeletonized and non-skeletonized IMAs are compared.
Proposed benefits of skeletonization include increased flow and length, decreased sternal infection rates, and reduced pain. However, these assertions are supported primarily by nonrandomized, observational studies. Not surprisingly, there is considerable debate about the optimal harvesting technique for the IMA.
Reduced pain and dysesthesia with improved sternal perfusion is associated with IMA skeletonization. It doesn’t improve conduit flow but may increase conduit length. Skeletonization can reduce the morbidity associated with IMA harvest in patients undergoing CABG.
Our study was conducted on fifty patients whom were permuted divided into two groups according to IMA harvesting technique used. Skeletonized BIMA harvesting was used in group A while pedicled LIMA and skeletonized RIMA harvesting was used in group B.