Histologic and physiologic evaluation of skeletonized internal thoracic artery harvesting with an ultrasonic scalpel

Higami, Tetsuya; Maruo, Ayako; Yamashita, Teruo; Shida, Tsutomu; Ogawa, Kenji

doi:10.1067/mtc.2000.110189

Cited by 62 publications

(27 citation statements)

References 13 publications

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“…These results were found, probably as a result of better sternal perfusion after ITA skeletonization compared to the pedicled ITA [22][23][24][25][26][27][28]. Boodhwani et al [26] conducted a study with 48 patients, in which each individual was submitted to CABG using bilateral ITA, and all ITAs were dissected skeletonized in the left side and pedicled in the right side.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Section: Discussionmentioning

confidence: 99%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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“…The histological study confirmed that a different devices such as ultrasonic scalpel or high frequency electrocotery application on the branches more than 1 or 5 mm away from the ITA itself did not cause any endothelial injury [11,12]. Therefore, our investigation was done by carrefully observation during the harvesting with the aid of low voltage electrocotery.…”

Section: Discussionmentioning

confidence: 83%

Histologic examination of the clipped internal thoracic artery by transmission electron microscope in patients undergoing coronary artery bypass grafting

Ozkara¹

2012

WJCD

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Objectives: As we known that the internal thoracic artery (ITA) has an excellent patency rate in coronary artery bypass grafting (CABG). However, early graft failure due to occlusion and spasm is still the major problem after coronary artery bypass surgery. We examined histopathologic findings of the clipped internal thoracic artery (ITA) in patients undergoing CABG using transmission electron microscope (TEM). Methods: To investigate the histopathololojic ITA examination, 60 patients were randomly selected. The ITA was harvested in a standart fashion with the use of low voltage electrocotery and its distal end was cut prior to bifurcation and clipped. Just before the ITA anastomosis 1 mm lenght of ITA ring was cut and saved in 2.5% Glutaraldehide solution for fixation and examination of transmission electron microscope (TEM). One blinded anatomopatholog examined all specimens and described the endothelial integrity according to the score system proposed by Fischlein et al. Results: In ten cases (17.5%) different degree of histopathologic findings (endothelial cells, intercellular and intracellular organels and adventitia) were recorded The most important histopatholojic findings of ITA were as follows: endothelial vacuolisation, intimal thickening and/or intimal seperation, subendothelial edema, swallowing of cytoplasma and mitocondria. Conclusion: Our results showed that the endothelial pathology is high when the ITA clipped. Unfortunataly, because our study did not include the non-clipped ITA we have not concluded the comparison or statistical results. In our opinion, for absolute definition of the effects of the clipping the ITA it should be planned the comparative results between the clipped and non-clipped ITA histologic examinations.

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“…Higami et al [10] presented histological results of tissue submitted to USS, demonstrating its safety when used at a distance of more than 1 mm from the vessel; less than 1 mm may cause slight injuries in adjacent tissues. With coagulation resulting from collagen molecule degradation, the emanated heat is around 50ºC to 60ºC.…”

Section: -Final Aspect Of Skeletonized Internal Thoracic Arterymentioning

confidence: 99%

“…We use level 3 USS power. The intercostal branches are coagulated for 2 to 3 seconds and sectioned as far from the arterial wall as possible (at least 1 mm from the ITA) (Figure 3), so that adjusted protein coagulation of the branches is possible and not to damage the ITA trunk [10]. We adopted the hook-type blade and considered level 3 ideal, because it presented good coagulation with a slower cut.…”

Section: Dissection Of Internal Thoracic Arterymentioning

confidence: 99%