Functional And Histological Analysis Of The Radial Artery: Comparison Of Open Vs Endoscopic Vessel Harvesting
Stefan C. Sandker1, Ron GH Speekenbrink1, Robert PH Storm van Leeuwen1, Gianclaudio Mecozzi1, Gert-Jan Toes2, Hendrik Buikema3, Jan G. Grandjean1.
1Thoraxcenter Twente, Enschede, Netherlands, 2Laboratorium Pathologie Oost Nederland, Hengelo, Netherlands, 3Department of Clinical Pharmacology, University Medical Center Groningen, Enschede, Netherlands.
OBJECTIVE: Over the past two decades the radial artery has regained its popularity as bypass graft. However, vasospasm of the radial artery graft is correlated to early graft failures in CABG. Endoscopic vessel harvesting results in fewer wound complications and is cosmetically superior compared to the open technique, but may injure the graft and promote vasospasm. We investigated vascular function in organ bath experiments and analyzed the histological structure of radial arteries harvested by either a latest generation endoscopic vessel harvesting system or open technique.
METHODS: In this prospective trial the radial artery was harvested using the open (n=14) or endoscopic (n=29) technique, based on surgeons preference, of patients undergoing CABG. Surplus proximal radial artery segments were collected and pairwise assessment of vasoreactivity to acetylcholine, nitroglycerin, norepinephrine and potassium chloride was performed in organ bath experiments. Histological assessment was done by an expert pathologist and sections were stained with hematoxylin-eosin, Verhoeff van Gieson’s and CD31 (open: n=9, endoscopic: n=6).
RESULTS: Endothelium dependent and independent vasorelaxation to respectively acetylcholine (p=0.912) and nitroglycerin (p=0.563) was similar for endoscopically harvested compared to open harvested radial arteries. Vasoconstriction to norepinephrine (p=0.429) and potassium chloride (p=0.756) was similar for open and endoscopic harvested radial arteries. Histological examination showed an intact endothelium, some intima fibrosis and intact media layer in all radial artery sections for both techniques. All artery segments showed no signs of acute vessel damage or inflammation.
CONCLUSIONS: Vascular function and histological structure of the radial artery is not altered by the latest generation endoscopic vessel harvesting system compared to the open technique. Therefore, we suggest that endoscopic vessel harvesting of the radial artery in CABG is a good alternative compared to open vessel harvesting. In sight of wound complications and cosmetics endoscopic vessel harvesting of the radial artery should be encouraged.
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