[Graft harvesting in coronary artery bypass grafting]

The technique of graft harvesting during coronary artery bypass grafting (CABG) consists of 2 main components: the vessel exposure at an adequate layer and the division of branches. Recently, the ultrasonic scalpel has been used for skeletonization of arterial grafts. A hook-type tip is used for the internal thoracic artery and the radial artery graft, while a shear type tip is used for the right gastroepiploic artery graft. The ultrasonic scalpel is useful both for graft vessel exposure and for the division of branches. The cavitation phenomenon is useful for the vessel exposure, while ultrasonic protein coagulation is useful for the division of branches. In endoscopic saphenous vein graft harvesting, electrocautery scissors are used for the division of branches. Avoiding thermal damage to the graft vessel is important in the use of either device. In any graft harvesting, direct contact with the main trunk should be avoided as much as possible to prevent damage. A thorough knowledge of the anatomy of the graft vessel and the surrounding organs is necessary for graft harvesting and to avoid complications. Furthermore, an understanding of characteristics of the harvesting devices is also important.