Reevaluation of Two Techniques of Harvesting the Skeletonized Internal Mammary Artery

Abstract

Background: Selective skeletonization of the internal mammary artery (IMA) without adjacent vasculo-muscular structures reduces trauma to the chest wall, results in elongated grafts, makes ideal graft positioning possible, and eliminates the need to implant a dissected or hypoplastic graft with direct visual control of the vessel. We compared two techniques of skeletonizing the IMA in a prospective randomized trial.

Methods: 51 IMAs were randomly harvested and divided into two groups according to the technique of skeletonization. In group I (n = 31), IMAs were harvested in a skeletonized fashion with the Harmonic Ultrasonic scalpel, and in group II (n = 20) using scissors and hemostatic clips. We compared arterial wall histology, harvesting time, spasm frequency, and the use of hemostatic clips between the two groups.

Results: There were no significant morphological differences in the arterial wall in the two groups. Use of an ultrasonically-activated scalpel reduced the IMA's harvesting time (p < 0.001), the frequency of spasm (p = 0.01), and the use of hemostatic clips (p < 0.001).

Conclusions: Ultrasonic harvesting of a skeletonized IMA is a non-traumatic preparatory technique that reduces the costs of surgical clips and that can be performed safely and quickly.

Key words

coronary bypass surgery - cardiovascular surgery - myocardial infarction - ultrasonically‐activated scalpel - skeletonized internal mammary artery - IMA - coronary surgery - CABG

References

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1 The first two authors contributed equally to this manuscript.