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Eur J Cardiothorac Surg 2004;25:208-211
© 2004 Elsevier Science NL

Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy

^a Department of Cardiovascular Surgery, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, Fukuoka 830-8577, Japan
^b Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan

Received 12 September 2003; received in revised form 5 November 2003; accepted 11 November 2003.

^* Corresponding author. Tel.: +81-942-38-2222; fax: +81-942-38-2248
e-mail: myoshi{at}toq.ne.jp

Objective: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of the ultrasonically skeletonized ITA is a major concern related to this technique. The purpose of this study is to assess the endothelial integrity of the ultrasonically skeletonized ITA. Methods: We skeletonized the left ITA with an ultrasonic scalpel in nine patients who underwent CABG, and thereafter the terminal portion of this artery was subjected to a morphological study. The endothelial integrity of this artery was morphologically assessed using scanning electron microscopy, and the results were compared to that of the left ITA skeletonized with fine scissors. Results: All ITA specimens showed a completely confluent endothelium, and no endothelial injury was observed by the scanning electron microscopic study. Conclusions: The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.

Key Words: Ultrasonic scalpel • Skeletonization • Endothelium • Internal thoracic artery • Scanning electron microscopy

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