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J Thorac Cardiovasc Surg 1995;109:21-29
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

The use of methylene blue as an extravascular surgical marker impairs vascular responses of human saphenous veins

Athens and Augusta, Ga.

Supported by the Georgia Heart Association and the American Foundation for Pharmaceutical Education.

Received for publication Dec. 23, 1993. Accepted for publication May 10, 1994. Address for reprints: Randall Tackett, PhD, Associate Professor and Head, Pharmacology & Toxicology, College of Pharmacy, University of Georgia, Athens, GA 30602-2356.

Abstract

Methylene blue is occasionally applied to the adventitia of blood vessels during coronary artery bypass and other vascular procedures to assist in the orientation of the vessel. Inherent in this method is the assumption that extravascular application of methylene blue is innocuous with regard to vascular function. In the first part of this study, the in vitro vascular reactivity of methylene blue-labeled saphenous veins was compared with that of veins that were not marked with methylene blue. The vasoactive agents tested were designed to examine multiple pathways. They included potassium chloride, prostaglandin F_2a , phenylephrine, serotonin, angiotensin II, BHT-933 ( ₂ -adrenergic agonist), sodium nitroprusside, acetylcholine, isoproterenol, and verapamil. Compared with unmarked veins, those marked with methylene blue demonstrated a significant impairment of both vasoconstrictor and vasodilator function. These observations were made on a relatively small number of patients and could therefore be attributed to inherent differences between patients or surgical procedures. In the second part of this study, these variables were eliminated by dividing a single vein from one patient into three segments for a 45-minute exposure to external only methylene blue, internal and external methylene blue, or no methylene blue. The segments were then evaluated for vasoreactivity in vitro. Externally applied methylene blue reduced vasoconstriction regardless of the agonist. Further, both endothelium-dependent and -independent vasodilation was diminished by external methylene blue exposure. In veins exposed to methylene blue both internally and externally the results were similar but the magnitude of impairment greater. It is concluded that surgical marking of blood vessels with methylene blue has the potential to adversely affect vascular reactivity and therefore the use of alternative dyes should be considered. (J THORACIC CARDIOVASC SURG 1995;109:21-9.)

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