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Ann Thorac Surg 2003;75:1681-1682
© 2003 The Society of Thoracic Surgeons

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Correspondence

Skeletonization of arterial conduits: method of choice

Advanced Cardiology Center, PO Box 6684, Marina Station, Mayaguez, Puerto Rico 00681-6684

To the Editor:

We read with great interest the article by Amauro and colleagues [1].

Since 1999 we have used the technique of skeletonization of the radial artery in more than 100 patients. Our technique involves exposure of the radial artery bundle from the wrist toward the antecubital fossa, topically irrigating the vessel with diluted milrinone (2 mg/30 mL normal saline) [2].

The radial artery is surrounded with a silicone elastomer tape. Gentle retraction of the tape allows mobilization of the radial artery. We use low-power electrocautery set at 20 W to minimize heat damage to the artery. With the spatula tip of the cautery, the adjacent veins are carefully separated. Side branches are electrocoagulated at least 1.5 mm away from the main radial artery.

Lapuerta and associates [3] have proposed a technique to safely elongate the radial artery for use in trauma cases. If one gently "pulls" the radial artery with the fingertip, it elongates a bit and becomes easier to manipulate without damage.

Invariably, when one divides the radial artery at the wrist, arterial flow is reduced, probably as a result of spasm. Twenty milliliters of diluted heparin solution is gently infused with an angiocatheter in a retrograde manner. The radial artery is clamped at its proximal end, and 20 mL of diluted milrinone (2 mg/30 mL of normal saline) solution is administered to provide gentle hydrostatic dilation. The proximal artery is then clamped and divided. The graft is left immersed in a heparin-milrinone solution (10,000 U heparin, 10 mg milrinone in 1,000 mL of normal saline).

We exclusively use the skeletonization technique for our internal thoracic artery harvests using the electrocautery as described above. The use of this technique for the radial artery is just an extension of the method we have used for many years.

Skeletonization of the mammary arteries and the radial arteries and treatment with milrinone result in excellent conduits, free of spasm, which are easier to use and have excellent flow characteristics.

We congratulate Amauro and colleagues for this excellent article.

References

1. Amauro A., Takahashi A., Hirose H. Skeletonized radial artery grafting: improved angiographic results. Ann Thorac Surg 2002;73:1880-1887.[Abstract/Free Full Text]
2. García-Rinaldi R., Soltero E.R., Carballido J., Mojica J. Intraluminal milrinone for dilation of the radial artery graft. Tex Heart Inst J 1999;26:189-191.[Medline]
3. Lapuerta L., Jr, Shayani P., Ruiz-Razura A., Cohen B.E. Long-term clinical experience with the Ruiz-Cohen intraoperative arterial expanders. Plast Reconstr Surg 2002;109:1123-1127.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by García, R. Articles by Sosa-Faría, J. Search for Related Content PubMed Articles by García, R. Articles by Sosa-Faría, J. Related Collections Coronary disease