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Comparative Study
. 2008 Nov;136(5):1302-8.
doi: 10.1016/j.jtcvs.2008.05.060.

Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography

Philip S Brazio  1 , Patrick C Laird, Chenyang Xu, Junyan Gu, Nicholas S Burris, Emile N Brown, Zachary N Kon, Robert S Poston
Affiliations
Comparative Study

Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography

Philip S Brazio et al. J Thorac Cardiovasc Surg. 2008 Nov.

Abstract

Objective: Vasospasm is the primary obstacle to widespread adoption of the radial artery as a conduit in coronary artery bypass grafting. We used optical coherence tomography, a catheter-based intravascular imaging modality, to measure the degree of radial artery spasm induced by means of harvest with electrocautery or a harmonic scalpel in patients undergoing coronary artery bypass grafting.

Methods: Radial arteries were harvested from 44 consecutive patients with a harmonic scalpel (n = 15) or electrocautery (n = 29). Vessels were imaged before harvesting and after removal from the arm, with saphenous vein tracts serving as internal controls. Optical coherence tomographic findings for the degree of harvesting-induced injury were validated against histologic measures.

Results: Optical coherence tomographic measures of endovascular dimensions and injury correlated strongly with histologic findings. Mean luminal volume, a measure of vasospasm, decreased significantly less after harvesting with a harmonic scalpel (9% +/- 7%) than with electrocautery (35% +/- 6%, P = .015). Completely intact intima was present in 11 (73%) of 15 radial arteries harvested with a harmonic scalpel (73%) compared with 9 of 29 arteries harvested by means of electrocautery (31%, P = .011). Intraoperative flow measurements and patency rates at 5 days postoperatively were not significantly different among groups.

Conclusions: Optical coherence tomography provides a level of speed and accuracy for quantifying endothelial injury and vasospasm that has not been described for any other modality, suggesting potential as an intraoperative quality assurance tool. Our optical coherence tomographic findings suggest that the harmonic scalpel induces less spasm and intimal injury compared with electrocautery.

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Figures

FIGURE 1
FIGURE 1
Localization of the optical coherence tomographic imaging probe within the radial artery. The infrared light emitted from the tip of the optical coherence tomographic probe (A) can easily be visualized through the luminal wall of the radial artery (arrow, B) during image acquisition. This enables external marking of abnormal areas of the artery, thereby providing a roadmap for selecting the optimal portion of the conduit for bypass. Imaging-guided biopsy specimens also can be obtained for histologic confirmation of optical coherence tomographic findings.
FIGURE 2
FIGURE 2
Endothelial integrity of harvested radial artery portions according to histologic findings (CD31 staining, A and D; elastin staining, B and E) and optical coherence tomographic analysis (C and F). A, B, and C, Normal artery portions; D, E, and F, artery portions with dissection.
FIGURE 3
FIGURE 3
Optical coherence tomographic frames at 3 points of the radial artery before (A and C) and after (B and D) harvest. The mean luminal area (LA) of the artery harvested with the harmonic scalpel (A and B) increased by 6.5%, whereas the LA of the artery harvested by means of electrocautery decreased by 66.9% (C and D). After harvesting, panel B shows small areas of mild focal spasm, whereas panel D displays severe diffuse spasm (string sign).
See this image and copyright information in PMC

References

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