title: Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy.
abstract: The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.
authors.forename: Burak
authors.initials: B
authors.lastname: Onan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yeniterzi
authors.forename: Ismihan Selen
authors.initials: IS
authors.lastname: Onan
authors.forename: Burak
authors.initials: B
authors.lastname: Ersoy
authors.forename: Suheyla
authors.initials: S
authors.lastname: Gonca
authors.forename: Elif
authors.initials: E
authors.lastname: Gelenli
authors.forename: Seyhun
authors.initials: S
authors.lastname: Solakoglu
authors.forename: Ihsan
authors.initials: I
authors.lastname: Bakir
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D004210:Dissection; D004564:Electrocoagulation; D042783:Endothelial Cells / Q000648:ultrastructure*; D004730:Endothelium, Vascular / Q000601:surgery* / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery* / Q000648:ultrastructure*; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology / Q000601:surgery; D020858:Tissue and Organ Harvesting
keywords: Coronary artery bypass/methods; electrocoagulation/methods; endothelium, vascular/injuries/pathology/ultrastructure; microscopy, electron, scanning; risk assessment; thoracic arteries/pathology/surgery/transplantation/ultra-structure