Psacioğlu H, Atay Y, Cetindağ B, Saribülbül O, Buket S, Hamulu A
Cardiovascular Surgery Department, Ege University Medical Faculty, Bornova-Izmir, Turkey.
Ann Thorac Surg. 1998 Apr;65(4):984-5. doi: 10.1016/s0003-4975(98)00059-9.
The radial artery was proposed and then abandoned as a coronary artery bypass graft in the 1970s. Development of new pharmacologic antispasmodic agents and minimally traumatic harvesting techniques has led to a revival of the use of the radial artery in coronary artery bypass surgery. Usually the main reasons for the spasm are thermal injury caused by electrocautery and traumatic harvesting technique.
In our technique an ultrasonically activated scalpel (Harmonic Scalpel; Ultracision Inc, Smithfield, RI) was used for radial artery harvesting without using hemostatic clips for vessel side branches. The patients in the study were divided into two groups of 10 patients each. In the first group radial arteries were harvested with this technique, and in the second group with hemostatic clips, scissors, and minimal electrocautery. Harvesting time, frequency of spasm, and use of hemostatic clips were compared between the two groups.
The Harmonic Scalpel decreased the harvesting time, frequency of spasm, and excessive use of hemostatic clips.
Good coagulation capacity with markedly decreased use of hemostatic clips and minimized thermal injury offers the surgeon the ability to perform less traumatic, spasm free, and rapid radial artery harvesting.
20世纪70年代，桡动脉曾被提议用于冠状动脉旁路移植术，但随后被弃用。新型抗痉挛药物和微创获取技术的发展使得桡动脉在冠状动脉旁路手术中的应用得以复兴。通常痉挛的主要原因是电灼造成的热损伤和创伤性获取技术。
在我们的技术中，使用超声刀（谐波手术刀；超声切割止血刀，美国史赛克公司，罗德岛州史密斯菲尔德）获取桡动脉，血管分支不使用止血夹。研究中的患者分为两组，每组10例。第一组用该技术获取桡动脉，第二组用止血夹、剪刀并尽量少用电灼获取桡动脉。比较两组的获取时间、痉挛频率和止血夹的使用情况。
谐波手术刀减少了获取时间、痉挛频率和止血夹的过度使用。
良好的凝血能力，显著减少止血夹的使用并将热损伤降至最低，使外科医生能够进行创伤更小、无痉挛且快速的桡动脉获取。
