Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit.
BACKGROUND
The radial artery's propensity for vasospasm and vulnerability to surgical trauma are well known. A less invasive endoscopic method to harvest the radial artery was recently introduced, but its effect on radial artery integrity is unknown.


METHODS
To compare the effects of harvest method on radial artery function, we prospectively randomized 54 patients undergoing coronary artery bypass grafting with the radial artery into 3 groups on the basis of harvest techniques: endoscopic, conventional with cautery, and conventional with harmonic scalpel. We assessed endothelium-dependent and endothelium-independent relaxation of radial artery segments to sequential doses of acetylcholine and nitroglycerin, respectively, using standard organ-chamber methodology. Vasospasm was assessed as the vasoconstrictor response to the thromboxane analog U46619. We assessed endothelial integrity using light and electron microscopy and by rating intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and P-selectin expression by means of immunohistochemistry on a semiquantitative 0- to 3-point scale. Harvest procedures were performed by a single surgeon, and data analyses were blinded to the harvesting method.


RESULTS
Maximal relaxation-contraction responses to acetylcholine, nitroglycerin, and U46619 and effective drug concentration yielding 50% response were similar in the 3 groups. Adhesion molecule expression and histologic changes, as assessed by means of light and electron microscopy, were similar in the 3 groups.


CONCLUSIONS
Endoscopic harvest does not alter radial artery vasoreactivity or endothelial integrity compared with conventional harvest techniques. Because the endoscopic technique is less invasive, it might prove to be the technique of choice to harvest the radial artery.
Shapira
Oz M
OM
Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Mass 02118, USA. oz.shapira@bmc.org
Eskenazi
Benjamin R
BR
Anter
Elad
E
Joseph
Lija
L
Christensen
Thomas G
TG
Hunter
Curtis T
CT
Lazar
Harold L
HL
Vita
Joseph A
JA
Shemin
Richard J
RJ
Keaney
John F
JF
D019796:15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid / Q000494:pharmacology; D001026:Coronary Artery Bypass; D004724:Endoscopy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D066298:In Vitro Techniques; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000032:analysis; D017534:Radial Artery / Q000166:cytology / Q000187:drug effects / Q000378:metabolism / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D019007:P-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D014662:Vasoconstrictor Agents; D018799:Intercellular Adhesion Molecule-1; D019796:15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid