ABSTRACT
Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Radial Artery/surgery , Tissue and Organ Harvesting/methods , Dissection/methods , Electrocoagulation/methods , Ultrasonic Surgical Procedures/methods , Postoperative Period , Coronary Artery Bypass/methods , Radial Artery/pathology , Intercellular Adhesion Molecule-1 , Postoperative HemorrhageABSTRACT
OBJECTIVE: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). METHODS: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. RESULTS: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. CONCLUSION: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.
Subject(s)
Dissection/methods , Electrocoagulation/methods , Radial Artery/surgery , Tissue and Organ Harvesting/methods , Ultrasonic Surgical Procedures/methods , Aged , Coronary Artery Bypass/methods , Female , Humans , Intercellular Adhesion Molecule-1 , Male , Middle Aged , Postoperative Hemorrhage , Postoperative Period , Radial Artery/pathologyABSTRACT
Carotico-jugular fistulae are known complications of gunshot injuries and stab wounds, but they can be iatrogenic. Untreated, these lesions may lead to heart failure, endocarditis, or cerebral embolization. We present the computerized tomography (CT)-angiographic view and its value in the treatment strategy in carotico-jugular fistula. A 35-year-old male was referred in the second hour of a ballistic injury to the right side of the neck. Physical examination revealed hematoma, exit hole and thrill on the right sternocleidomastoid muscle. Diagnosis was confirmed with Doppler ultrasound and CT angiography. Surgical interposition with 6 mm polytetrafluoroethylene for the carotid artery and with 12 mm Dacron for the internal jugular vein was performed. The fistulous tract was ligated. In the postoperative sixth month, Doppler ultrasound was normal and the patient was on antiaggregant therapy and healthy.
