title: Adventitial dissection: a simple and effective way to reduce radial artery spasm in coronary bypass surgery.
abstract: OBJECTIVE
  Over the last two decades, the radial artery (RA) has become a routinely used conduit for coronary artery bypass graft surgery. One potential disadvantage of the radial artery is its higher susceptibility to vasospasm compared with other arterial grafts. We investigated whether adventitial dissection of the radial artery can reduce vasoconstriction and increase free blood flow.
  
  
  METHODS
  Following harvesting, the adventitia of the radial artery was dissected using coronary scissors. Surplus distal radial artery segments (n = 35) with and without adventitial dissection of patients undergoing coronary artery bypass surgery were collected and pairwise assessment of vasoreactivity to potassium chloride, U46619 and acetylcholine was performed in organ bath experiments. Free blood flow was measured before and after adventitial dissection.
  
  
  RESULTS
  Full curve and maximal vasoconstriction of the RA to potassium chloride (P = 0.015 and 0.001) and U46619 (P = 0.048 and 0.001) was significantly reduced after adventitial dissection compared with non-adventitial dissected radial arteries. Endothelium-dependent relaxation to acetylcholine of adventitial dissected radial arteries was significantly increased (P = 0.006) compared with non-adventitial dissected radial arteries. Maximal vasorelaxation to acetylcholine was significantly increased for adventitial dissected radial arteries compared with non-adventitial dissected radial arteries (P = 0.018). Free blood flow was significantly increased after adventitial dissection (P = 0.037).
  
  
  CONCLUSIONS
  The adventitial dissected radial artery is less susceptible to vasoconstriction and more prone to vasorelaxation ex vivo and shows an increased free blood flow. Therefore, we suggest adventitial dissection of the radial artery graft to reduce vasospasm for arterial revascularization in coronary artery bypass surgery.
authors.affiliation: Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Sandker
authors.forename: Gianclaudio
authors.initials: G
authors.lastname: Mecozzi
authors.forename: Azuwerus
authors.initials: A
authors.lastname: van Buiten
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
authors.forename: Hendrik
authors.initials: H
authors.lastname: Buikema
authors.forename: Jan G
authors.initials: JG
authors.lastname: Grandjean
mesh_terms: D063194:Adventitia / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000601:surgery*; D003326:Coronary Circulation; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D011446:Prospective Studies; D017534:Radial Artery / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D014664:Vasodilation; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents
keywords: Coronary artery bypass graft arterial grafts; Coronary artery bypass graft new technology; Off-pump surgery; Vascular tone and reactivity