Ronan J W, Perry L A, Barner H B, Sundt T M
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
Ann Thorac Surg. 2000 Jan;69(1):113-4. doi: 10.1016/s0003-4975(99)01193-5.
The radial artery (RA) is used increasingly for myocardial revascularization. Having an ultrasonic dissector available in our unit, we began to use it for RA harvest with the impression that harvest spasm might be less for the new technique.
We compared RA harvest using standard techniques (21 RA) with ultrasonic dissection (41 RA) in which all branches were divided between clips with scissors in the former and bleeding branches were clipped in the latter.
Harvest times were not different. Conventional technique used 74+/-18 (mean +/- standard deviation) clips versus 3.2+/-4.3 clips (p<0.001). In situ free flow was 17.2+/-20.7 mL/min for conventional technique versus 52.5+/-48.1 for ultrasonic (p<0.001). Free flow after the proximal anastomosis to the left internal thoracic artery was 38.5+/-60.4 mL/min for conventional technique and 50.7+/-29.6 for ultrasonic (p = 0.008). Free flow 10 minutes after intraluminal papaverine was 78.5+/-45.9 mL/min for usual technique versus 102.8+/-51.7 for ultrasonic (p = 0.016). No patient required reoperation for bleeding.
Ultrasonic dissection of the RA is associated with decreased RA spasm, good hemostasis, no additional harvest time, and has become our standard technique.
桡动脉（RA）越来越多地用于心肌血运重建。由于我们科室有超声解剖器，我们开始使用它来获取桡动脉，认为新技术可能减少获取过程中的痉挛。
我们比较了使用标准技术（21例桡动脉）与超声解剖技术（41例桡动脉）获取桡动脉的情况，前者用剪刀在夹子间切断所有分支，后者则夹住出血分支。
获取时间无差异。传统技术使用74±18（均值±标准差）个夹子，而超声解剖技术使用3.2±4.3个夹子（p<0.001）。传统技术原位自由血流为17.2±20.7 mL/分钟，超声解剖技术为52.5±48.1 mL/分钟（p<0.001）。与左胸廓内动脉近端吻合后的自由血流，传统技术为38.5±60.4 mL/分钟，超声解剖技术为50.7±29.6 mL/分钟（p = 0.008）。腔内注射罂粟碱10分钟后的自由血流，传统技术为78.5±45.9 mL/分钟，超声解剖技术为102.8±51.7 mL/分钟（p = 0.016）。无患者因出血需要再次手术。
桡动脉的超声解剖与桡动脉痉挛减少、止血良好、不增加获取时间相关，已成为我们的标准技术。
