Technical Aspects of Harvesting the Radial Artery with the Harmonic Scalpel
DOI:
https://doi.org/10.1532/hsf.826Abstract
Background: Harvesting the radial artery (RA) with ultrasonic dissection with the Harmonic Scalpel reduces spasm induced by surgical handling. Topical exposure to phentolamine methanesulphonate (Regitine) exerts an additional effect of vasodilatation.
Methods: Between January and December 2002, the RA was harvested as a pediculated vessel with the Harmonic Scalpel in 145 consecutive patients undergoing myocardial revascularization. A fasciotomy of the pedicle was performed after harvesting. A composite graft with the reverse free RA on the in situ left internal thoracic artery (ITA) was prepared before the construction of distal coronary anastomoses. The RA was then placed in a syringe filled with Regitine (0.07
g/mL) for 10 minutes.
Results: The mean number of grafts/patient was 3.0. The mean number of RA anastomoses was 2.0/patient. Left ITA free flow was 105 ± 34 mL/min. Regitine increased the RA free flow from 60 ± 35 mL/min to 82 ± 30 mL/min (P < .05). Fourteen patients underwent postoperative coronary angiography. All RA anastomoses were patent.
Conclusion: The compound effect of RA harvesting with the Harmonic Scalpel and topical treatment with the a blocking agent Regitine increases the RA free flow and significantly decreases intraoperative spasticity.
References
Carpentier A. 1975. In discussion of Geha AS, Krone RJ, McCormick JR, Baue AE. 1975. Selection of coronary bypass: anatomic, physiological, and angiographic considerations of vein and mammary artery grafts. J Thorac Cardiovasc Surg 70:414-31.nCarpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. 1973. The aorta-to-coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nChardigny C, Jebara VA, Acar C, et al. 1993. Vasoreactivity of the radial artery: comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery. Circulation 88:II115-27.nDipp MA, Nye PCG, Taggart DP. 2001. Phenoxybenzamine is more effective and less harmful than papaverine in the prevention of radial artery vasospasm. Eur J Cardiothorac Surg 19:482-6.nHarrison WE, Mellor AJ, Clark J, Singer DR. 2001. Vasodilator pretreatment of human radial arteries: comparison of effect of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro. Eur Heart J 22:2209-16.nHe GW, Yang CQ. 1995. Comparison among arterial grafts and coronary artery: an attempt at functional classification. J Thorac Cardiovasc Surg 109:707-15.nHe GW, Yang CQ. 1997. Radial artery has higher receptor-mediated contractility but similar endothelial function compared with mammary artery. Ann Thorac Surg 63:1346-52.nHe GW, Yang CQ. 1998. Characteristics of adrenoceptors in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 115:1136-41.nLocker G, Mohr R, Paz Y, et al. 2002. Pretreatment with a-adrenergic blockers for prevention of radial artery spasm. Ann Thorac Surg 74:S1368-70.nManasse E, Sperti G, Suma H, et al. 1996. Use of the radial artery for myocardial revascularization. Ann Thorac Surg 62:1076-83.nPosacioglu H, Atay Y, Cetindag B, Saribulbul O, Buket S, Hamulu A. 1998. Easy harvesting of the radial artery with ultrasonically activated scalpel. Ann Thorac Surg 65:984-5.nTaggart DP, Dipp M, Mussa S, Nye PC. 2000. Phenoxybenzamine prevents spasm in radial artery conduits for coronary artery bypass grafting. J Thorac Cardiovasc Surg 120:815-7.nvan Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K. 1990. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 99:703-7.nAcar C, Jebara BA, Portoghese N, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-60.n
