Medalion Benjamin, Tobar Ana, Yosibash Zohar, Stamler Alon, Sharoni Erez, Snir Eitan, Porat Eyal, Hochhauser Edith
Department of Cardiac Surgery, Rabin Medical Center, Beilinson Campus, Israel.
Eur J Cardiothorac Surg. 2008 Oct;34(4):845-9. doi: 10.1016/j.ejcts.2008.06.015. Epub 2008 Jul 24.
Radial artery harvesting using the less invasive endoscopic technique involves dissection in a narrow tunnel and may cause an injury or induce vasospasm to the conduit. To assess this hypothesis, radial artery segments harvested endoscopically or conventionally were studied for reactivity and integrity.
Rings of radial arteries from 80 CABG patients who had their radial artery harvested either open (n=40) or endoscopic (n=40), were attached to a force transducer then subjected to norepinephrine (NE, 10(-6)M), acetylcholine (ACh, 10(-5)M), followed by sodium nitroprusside (SNP, 10(-7) to 10(-5)M) to test endothelial dependent and non-dependent relaxation. Vessels' integrity was assessed by microscopic staining with hematoxylin-eosin for muscle layers, Masson trichrome for collagen content and von Gieson for elastica layers.
Contraction and relaxation in response to NE, ACh and SNP were similar in both techniques. Arterial layers, collagen content and elastic lamina were preserved in all radial rings. Both techniques were found to be equally efficient in physiological and microscopic tests.
The similar reactivity and integrity of the radial artery in both techniques should encourage the less invasive endoscopic approach.
采用微创内镜技术获取桡动脉需要在狭窄通道内进行解剖，可能会对血管造成损伤或引发血管痉挛。为验证这一假设，对通过内镜或传统方法获取的桡动脉节段的反应性和完整性进行了研究。
从80例行冠状动脉旁路移植术（CABG）的患者中获取桡动脉，其中40例通过开放手术获取，40例通过内镜获取。将获取的桡动脉环连接到力传感器上，然后依次给予去甲肾上腺素（NE，10⁻⁶ M）、乙酰胆碱（ACh，10⁻⁵ M），随后给予硝普钠（SNP，10⁻⁷至10⁻⁵ M），以测试内皮依赖性和非依赖性舒张功能。通过苏木精-伊红染色观察肌层、Masson三色染色观察胶原含量、von Gieson染色观察弹性层，评估血管的完整性。
两种技术对NE、ACh和SNP的收缩和舒张反应相似。所有桡动脉环的动脉层、胶原含量和弹性膜均保存完好。在生理和显微镜检查中，两种技术的效率相当。
两种技术中桡动脉的反应性和完整性相似，这应鼓励采用微创内镜方法。
