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An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
Published on: September 8, 2023
Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma
Gil Bolotin1, Yoav Domany, Lorenza de Perini
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. bolotin@tasmc.health.gov.il
Insights
Intraoperative epiaortic ultrasonography (EAUS) is more sensitive than manual palpation for detecting atherosclerotic lesions in the ascending aorta during coronary artery bypass grafting (CABG). Routine use of EAUS can improve surgical decision-making and patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) carries a risk of cerebrovascular accident (CVA), often linked to aortic manipulation.
- Atherosclerotic material dislodged from the aorta during CABG can cause strokes.
Purpose of the Study:
- To evaluate the effectiveness of intraoperative epiaortic ultrasonography (EAUS) in detecting aortic atherosclerotic lesions.
- To determine if EAUS findings influence surgical decisions during CABG.
Main Methods:
- 105 patients undergoing CABG had intraoperative epiaortic ultrasonography (EAUS) using an 8-MHz transducer.
- Surgical strategy was assessed preoperatively, after manual aortic palpation, and after EAUS.
Main Results:
- Epiaortic ultrasonography (EAUS) detected atherosclerotic lesions in 38% of patients, with 17% identified by EAUS alone.
- Surgical strategy changed in 28% of patients, including conversion to off-pump CABG (OPCAB) in 24% based on EAUS findings.
- EAUS alone influenced aortic cannulation, cross-clamping, and anastomosis site selection in 17% of cases.
Conclusions:
- Epiaortic ultrasonography (EAUS) is more sensitive than manual palpation for identifying atherosclerotic lesions in the ascending aorta.
- EAUS provides crucial intraoperative information that impacts surgical decision-making during CABG.
- Routine use of EAUS is recommended for coronary artery bypass grafting (CABG) procedures to enhance safety and optimize surgical approach.
Objective:
A cerebrovascular accident (CVA) is a devastating complication of coronary artery bypass grafting (CABG) and a major cause for morbidity and mortality. Aortic manipulation, cannulation, and clamping during CABG may lead to release of atheromatous material from the ascending aorta, which may cause a CVA. This study assessed the hypothesis that the use of intraoperative epiaortic ultrasonography (EAUS) would supplement imaging information with that derived from manual aortic palpation and influence the surgical decision-making approach accordingly.
Methods:
After undergoing a mid-sternotomy for CABG, 105 patients underwent EAUS with an 8-MHz transducer ordinarily used for conventional transthoracic echocardiography. The surgical strategy was decided on at three stages: preoperatively, after manual aortic palpation, and following EAUS.
Results:
The preoperative strategy had assigned 105 patients to the "touched aorta" group that was planned for either on-pump or off-pump CABG (OPCAB) with proximal anastomosis to the aorta. Pathologic lesions of the atheromatotic ascending aorta were evident in 40 patients (38%), with the lesions detected in 22 patients (21%) by both palpation and EAUS, and in 18 patients (17%) by EAUS alone. The planned surgical strategy was changed in 29 patients (28%): 25 patients (24%) were converted from on-pump CABG to OPCAB, and the EAUS influenced the choice of the aortic cannulation, cross-clamping, and proximal anastomosis site in 4 patients (4%). Among the changes in surgical decision making, changes in 11 patients (10%) were based on lesion detection by both manual palpation and EAUS; in 18 patients (17%), changes resulted from pathologic evidence provided by EAUS alone.
Conclusions:
This study showed EAUS to be more sensitive in detecting atherosclerotic lesions than manual intraoperative palpation of the ascending aorta. This investigation contributes new data on the effect of EAUS on intraoperative surgical approach in the era of OPCAB. The use of EAUS has emerged as an important tool in intraoperative decision making, and we recommend its use routinely in CABG procedures.
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