Original Articles
Easy Harvesting of Radial Artery With Ultrasonically Activated Scalpel

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Abstract

Background. The radial artery was proposed and then abandoned as a coronary artery bypass graft in the 1970s. Development of new pharmacologic antispasmodic agents and minimally traumatic harvesting techniques has led to a revival of the use of the radial artery in coronary artery bypass surgery. Usually the main reasons for the spasm are thermal injury caused by electrocautery and traumatic harvesting technique.

Methods. In our technique an ultrasonically activated scalpel (Harmonic Scalpel; Ultracision Inc, Smithfield, RI) was used for radial artery harvesting without using hemostatic clips for vessel side branches. The patients in the study were divided into two groups of 10 patients each. In the first group radial arteries were harvested with this technique, and in the second group with hemostatic clips, scissors, and minimal electrocautery. Harvesting time, frequency of spasm, and use of hemostatic clips were compared between the two groups.

Results. The Harmonic Scalpel decreased the harvesting time, frequency of spasm, and excessive use of hemostatic clips.

Conclusions. Good coagulation capacity with markedly decreased use of hemostatic clips and minimized thermal injury offers the surgeon the ability to perform less traumatic, spasm free, and rapid radial artery harvesting.

Section snippets

Study Groups

In this study we harvested 20 radial arteries for coronary artery bypass grafting. We divided the patients into two equal groups. In the first group, radial arteries were harvested using the Harmonic Scalpel, and in the second group, hemostatic clips, scissors, and minimal electrocautery were used. The two groups were compared for harvesting time (the time spent between the radial artery skin incision and being fully prepared for anastomosis), frequency of spasm (the disappearance of visible

Results

Use of the Harmonic Scalpel decreased the harvesting time of the radial artery, frequency of spasm, and use of hemostatic clips (Table 1). The markedly decreased need to use hemostatic clips for side branches provided less traumatic, fast, spasm-free harvesting and easy handling during anastomosis. There was no need in any case to place additional hemostatic clips on the radial artery after it had been placed on the heart.

Comment

Arterial graft spasm is one of the most important issues in coronary artery bypass surgery. Usually it occurs during the graft harvesting. The main causes are surgical technique and thermal injury because of electrocautery [3]. Also, patency of the arterial graft may be jeopardized by the thermal injury.

This ultrasonically activated scalpel causes minimal thermal injury, and satisfactory coagulation eliminates the need to use hemoclips for side branches 4, 5. Harvesting technique without using

References (5)

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