Skeletonization of the internal thoracic artery: a randomized comparison of harvesting methods

We performed a randomized study to compare internal thoracic artery (ITA) flow response to two harvesting methods used in theskeletonization procedure: ultrasonic scalpel and bipolar electrocautery. Sixty patients scheduled for CABG were randomized to receiveeither ultrasonically (ns30 patients) or electrocautery (ns30 patients) skeletonized ITAs. Intraoperative ITA graft mean flows wereobtained with a transit-time flowmeter. ITA flows were evaluated at the beginning (Time 1) and at the end (Time 2) of the harvestingprocedure. Post-cardiopulmonary bypass (CPB) flow measurement (Time 3) was obtained in the ITA grafts anastomosed to the left anteriordescending artery. Intraoperative mean flow decreased significantly within ultrasonic group (Group U) and electrocautery group (Group E)at the end of the harvesting procedure (P-0.0001 in both cases). Within both groups the final mean flow measured on anastomosed ITAs(Time 3) was significantly higher than the beginning ITA flow value (Time 1). No statistical difference was noted comparing ITA flowsbetween the two groups at any time of evaluation. Skeletonization harvesting of the ITA produces a modification of the mean flow. Thequantity and the reversibility of this phenomenon, probably related to vasospasm, are independent from the energy source used in theskeletonization procedure.