Background: Papaverine is one the most widely used vasodilator agent to prevent İnternal thoracic artery (ITA) spasm. Diverse papaverine application techniques have been reported. The effects of topical and intraluminal papaverine applications on the ITA flow were compred in this study.

Methods: Fifty patients undergoing coronary artery surgery were studied in three different groups. Upon ITA harvesting, no vasodilator agent was applied in Group 1 patients while topical and intraluminal applications were used in Group 2 and 3, respectively. The two methods were compared by measuring ITA flows in three different times (before papaverine application: T1; before aortic cannulation: T2; before the coronary artery anastomosis: T3).

Results: The increase in ITA flow between T2 and T1 was statistically significant in all groups while the difference between T3 and T2 was significant in Groups 2 and 3. When the groups were compared, T2 flow in Group 2 was significantly higher than Groups 1 and 3, but Group 3 closed this difference during T3 measurements where Groups 2 and 3 flows were significantly higher than the control group.

Conclusions: Topical and intraluminal papaverine applications provide a considerable increase in ITA graft flow. Topical application provides this increase earlier than the intraluminal application and the flow increase is at least as effective as intraluminal application before the anastomosis. When the adverse effects of intraluminal ITA injection are considered, the preference of intraluminal application seems to be safer.

Keywords : İnternal thoracic artery, papaverine, graft spasm, arterial graft, vasodilator