Denervation of gastroepiploic artery graft can reduce vasospasm

Abstract

The removal of the periarterial sympathetic nerve from the human gastroepiploic artery reduced vascular contraction, elicited by peripheral nerve stimulation, without disturbing endothelial and smooth muscle contractile functions. This reduction may contribute to the prevention of vasospasms.

Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

“…Likewise, it has also been reported that denervation or skeletonization of the graft may reduce vasospasm of the GEA [8,77] and RA [78]. However, the impact of denervation or skeletonization on the graft spasm or patency has yet to be definitively confirmed.…”

“…Consider denervation or skeletonization. It has been hypothesized that denervation or skeletonization of the arteries used for grafting may disrupt the periarterial sympathetic nerves and prevent spasm [8].…”

“…During the last decade the potential additional survival advantage of a second IMA graft has been increasingly recognized [3]. In addition, other arteries such as the radial artery (RA) [4,5], and less commonly the right gastroepiploic artery (GEA) [6][7][8] and the inferior epigastric artery (IEA) [9,10], have been used as bypass grafts. However, with the exception of the IMA, other arterial grafts have a greater muscular component in the vessel wall and a consequent tendency to develop vasospasm during surgery.…”

Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

“…Skeletonization of grafts was initially used in IMA. It has been suggested that skeletonized arterial graft may denervate the vessel, reduce the risk of spasm, and improve graft patency in GEA [67][68][69] and RA [35], and this is often done with the ultrasonic scalpel [69]. Conversely, studies have demonstrated that skeletonization with an ultrasonic scalpel did not result in additional length and was more frequently associated with severe endothelial damage [70], and that en bloc free GEA graft, which has the gastroepiploic vein anastomosed to the right atrial appendage [71], can prevent graft spasm, leading to improved patency rate.…”

Current State-of-the-art of Coronary Artery Bypass Surgery

“…78) While offering superior long-term outcomes to SVGs, 18) there is considerable individual variability in characteristics, and arteriosclerosis is sometimes a problem. Although denervation by performing a skeletonized harvest has been experimentally shown to suppress spasms 24,79) tonus is also increased when compared with ITA grafts. 80) When using the GEA for in situ grafts, the anatomic target is the right coronary artery or the distal the circumflex branch.…”