Histological Analysis Of Radial Artery Grafts Following Endoscopic Harvesting With A Impedence-controlled Vessel Sealing System
Fabrizio Rosati1, Laura Giroletti1, Lorenzo Di Bacco1, Claudio Muneretto1, Giovanni Corsetti2, Gianluigi Bisleri3.
1Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy, 2Division of Anatomy, University of Brescia Medical School, Brescia, Italy, 3Division of Cardiac Surgery, Queen's University, Kingston, ON, Canada.
OBJECTIVE: Endoscopic radial artery harvesting(ERAH) leads to a reduced incidence of wound complications and improved recovery. Nevertheless, there are concerns due to potential conduit damage occurring during the use of a minimally invasive approach. We investigated the histological features of radial artery grafts following ERAH with a non-sealed approach.
METHODS: Twenty(20)consecutive patients undergoing CABG with the use of a radial artery were included in the study. ERAH was performed in all cases with a non-sealed approach, thus combining a reusable retractor and an impedance-controlled bipolar radiofrequency vessel sealing system. Samples from harvested radial arteries were immediately collected and fixed with 6% neutral formalin and finally embedded in paraffin. Histological evaluation was performed through optical microscopy and staining by means of hematoxylin/eosin and acid orcein in order to evaluate potential damage occurring in the arterial wall.
RESULTS: Mean patients’ age was 65.12±11.29 years and female gender was present in 20% of cases(4/20 pts). Four patients(20%) had diabetes and five(25%) peripheral artery disease. ERAH was successfully performed in all cases and no conversion to the open approach was required; mean harvesting time was 37.5±5min. No post-operative complications at the harvest site(such as bleeding, wound infection or tunnel haematoma)occurred in the current series. No macroscopic damage could be visually detected. At histological evaluation, no apoptotic sign of the endothelial cells’ nuclei at H&E staining could be identified as a consequence of thermal injury. Furthermore, no significant endothelial loss or damage to the internal lamina elastica could be observed. Finally, no significant margination of white blood cells, secondary to inflammatory response, could be demonstrated.
CONCLUSIONS: ERAH by means of a non-sealed approach with an impedence-controlled bipolar radiofrequency vessel sealing system is a safe and feasible procedure, with negligible damage to the harvested conduits at histological analysis. In particular, histological integrity and advantages of endoscopic procedure should encourage the use of this approach as first choice in radial artery harvesting.
Back to 2017 Posters