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Endothelium histological integrity after skeletonized dissection of the left internal mammary artery with ultrasonic scalpel

¹ Departments of Cardiac Surgery, Hospital "Virgen De La Salud", Servicio de Cirugia Cardiaca, Avenida de Barber 30, 45005 Toledo, Spain
² Departments of Pathology, Hospital, "Virgen De La Salud", Toledo, Spain

*Corresponding author. Tel.: +34 609955315; fax: 34 925269499 (upon request).

E-mail address: plima{at}sescam.jccm.es (P.P. Lima Cañadas).

Evaluate the endothelium histological changes produced in the left internal mammary artery (LIMA) after its dissection in a skeletonized manner with an ultrasonic scalpel. Two study groups were created in a prospective and randomized way: group A, 14 LIMA fragments skeletonized with a high frequency ultrasonic scalpel and group B (control group) with 14 specimens dissected with scissors and clips. The endothelium was studied in all 28 fragments fixing the segments with 10% formaldehyde, and paraffin inclusion. The arteries were sliced in 4 µm sections and stained with hematoxilin-eosin, and then evaluated by one single pathologist. In group A (ultrasonic scalpel) none of the specimens showed any endothelial damage, as did the samples in group B (control group). In both groups the endothelial wall was intact. There were chronic lesions in the form of intimal hyperplasia that might be in relation to the advanced age of both groups of patients. The left IMA dissection in a skeletonized fashion with an ultrasonic scalpel does not produce endothelial structural damage in it being similar to the one dissected with conventional methods. This permits its safe use, allowing us to benefit from the numerous advantages of arterial grafts usage in modern era coronary surgery.

Key Words: Coronary artery bypass surgery; Internal mammary artery; Surgical instruments