Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy

Yoshikai, Masaru; Ito, Tetsuhide; Kamohara, Keiji; Yunoki, Junji

doi:10.1016/j.ejcts.2003.11.013

Cited by 31 publications

(19 citation statements)

References 12 publications

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“…But skeletonization of the ITA preparation is more technically demanding and may be traumatic for the arterial wall. There are few reports explaining the effects of skeletonization on vessel-wall integrity [Deja 1999;Gaudino 1999;Ueda 2003;Yoshikai 2004].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and Histochemical Comparison of the Skeletonized and Pedicled Internal Thoracic Artery

Kandemir¹,

Büyükateş²,

Gün³

et al. 2007

The Heart Surgery Forum

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Although skeletonization of the ITA is a more technically demanding procedure, it provides some advantages such as increased available graft length and reduced sternal devascularization. This technique did not have any detrimental effects on the endothelial cell lining and e-NOS expressions on the endothelial layer. To reach a definitive judgment for using skeletonized ITA, we need information about the long-term angiographic patency rates.

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Section: Discussionmentioning

confidence: 99%

Intraoperative and Histochemical Comparison of the Skeletonized and Pedicled Internal Thoracic Artery

Kandemir¹,

Büyükateş²,

Gün³

et al. 2007

The Heart Surgery Forum

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“…Technically, skeletonization is often criticized for its longer harvesting time [22] and potential risk of damaging the ITA with elektrokoteterizasition [23,24]. Some publications have reported longer harvesting times for skeletonized versus conventional, non-skeletonized conduits, but it can be completed in 25-30 minutes in most cases [25,26].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG

Kara¹

2018

AJCEM

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The use of BITA is prominent in coronary bypass surgery due to its positive effects on long-term mortality and morbidity. However, its use is not widespread enough among heart surgeons due to its technical difficulty and the longer period of time it requires. There are still many articles being published on the subject. In patients who receive BITA, harvesting is usually performed in a skeletonized fashion. This protects the patient from sternal complications because it disturbs the vascularity of the chest wall less compared to the pedicled technique. However, the risk for injury on IMA is high. This is where harvesting in semi-skeletonized fashion distinguishes itself. Not only does it disturb the vascularity of the chest wall less but it also has a lower risk for thermal injury. Furthermore, it provides some advantages in terms of time over skeletonized fashion. The study enrolled 24 patients who underwent an isolated CABG operation using cardiopulmonary bypass (CPB) by a single surgeon between March 2017 -December 2017. 12 patients (10 males, 2 females; mean age: 55.083) underwent CABG operation using semi-skeletonized BITA (Table 1). Another 12 patients (8 males, 4 females; mean age: 56.25) underwent CABG using LIMA and venous graft. Post-operative sternal wound complications and post-operative pain of patients were compared. In the patients of the BITA group, cross clamp time, operation time and mammary harvesting time caused a slight prolongation. None of patients had deep sternal infection or mediastinitis or mechanical sternal dehiscence. BITA harvesting patients had more postoperative pain. As a result using semi-skeletonized ITA is more beneficial for sternal wound recovery compared to IMA harvested with the pedicled technique because the former causes less trauma in the thorax and disturbs the bleeding of the chest wall less. Furthermore, we think that it has advantages in terms of time and less traumatic effects on ITA compared to ITA harvested in a skeletonized fashion.

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“…In this study, microscopic analyzes were not performed although they are necessary to better evaluate the method. Lehtola et al [7] and Yoshikai et al [24] demonstrated, by electronic microscopy, that endothelial injuries of the ITA did not occur when USS was used.…”

Section: -Final Aspect Of Skeletonized Internal Thoracic Arterymentioning

confidence: 99%

Aspectos técnicos na esqueletização da artéria torácica interna com bisturi ultra-sônico

Menezes¹,

Vasconcelos²,

Lima³

et al. 2007

Rev Bras Cir Cardiovasc

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Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy

Abstract: The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.

Cited by 31 publications

References 12 publications

Intraoperative and Histochemical Comparison of the Skeletonized and Pedicled Internal Thoracic Artery

Intraoperative and Histochemical Comparison of the Skeletonized and Pedicled Internal Thoracic Artery

Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG

Aspectos técnicos na esqueletização da artéria torácica interna com bisturi ultra-sônico

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