Use of multidetector computed tomography angiography of upper limb circulation in patients undergoing coronary artery
Hasan B Altinsoy1, Ozkan Alatas2, Hidayet Kayancicek3
1Department of Radiology, Elazig Education and Research Hospital, Elazıg, Turkey.
Insights
Multidetector computed tomography (MDCT) angiography is a noninvasive tool to assess upper extremity arteries for coronary artery bypass grafting (CABG). It helps identify arterial anatomy and pathology, preventing unsuitable arterial conduit use, especially in diabetic patients.
Area of Science:
- Vascular Surgery
- Radiology
- Cardiology
Background:
- Coronary artery bypass grafting (CABG) often utilizes arterial conduits from the upper extremity.
- Preoperative assessment of forearm and hand arteries is crucial for selecting suitable conduits.
- Conventional angiography has limitations in detecting certain arterial pathologies.
Purpose of the Study:
- To evaluate the efficacy of 64-channel multidetector computed tomography (MDCT) angiography for assessing bilateral forearm and hand arterial circulation.
- To define criteria for upper extremity arterial anatomy and pathology using MDCT prior to arterial conduit harvesting.
- To identify potential complications or variations that could affect conduit selection in CABG.
Main Methods:
- A prospective study involving 55 patients undergoing total arterial CABG.
- MDCT angiography was performed for 110 forearm and hand arterial examinations.
- Allen tests were conducted pre-MDCT; patient history included diabetes mellitus (DM), peripheral artery occlusive disease, and smoking.
Main Results:
- MDCT clearly visualized all upper extremity arteries (axillary, ulnar artery (UA), radial artery (RA)).
- Arterial pathology was identified in 29.1% of patients, including severe calcification (RA/UA) in 6 patients with renal failure, and near-total RA occlusion in 2.
- Anatomic variations, such as a persistent median artery, were noted in 12.7% of patients.
Conclusions:
- MDCT angiography is a noninvasive and effective method for assessing upper extremity arterial anatomy and pathology.
- It can detect calcific plaques missed by conventional angiography, aiding in conduit selection for CABG.
- Preoperative MDCT imaging helps avoid forearm exploration and the use of unsuitable arterial conduits, particularly in patients with DM and renal impairment.
Objective:
This study aimed to evaluate the bilateral forehand circulation using a 64-channel multidetector computed tomography (MDCT) as a noninvasive method to define criteria for an upper extremity arterial anatomy and pathology prior to the use of arterial conduits.
Materials And Methods:
Fifty-five patients with coronary artery disease who underwent total arterial coronary artery bypass grafting (CABG) were randomly selected for this prospective study. MDCT angiography was performed for 110 examinations of forearm and hand arterial anatomy. Prior to MDCT, Allen tests were performed in all patients with a normal result, except four. Thirteen patients had diabetes mellitus (DM), 8 had peripheral artery occlusive disease, and 19 had a history of smoking.
Results:
All arteries, including axillary, ulnar artery (UA) and radial artery (RA), were clearly visualized in all patients. Upper extremity anatomical and pathological results were examined in 16 patients (29.1%). Severely calcified RA and/or UA were found in 6 patients who had a moderate renal failure. Nearly total occlusion of the RA was detected in another two patients. Focal intimal RA calcification was recorded in 1 female and 3 male patients. Ten patients who had severe calcification or intimal sclerosis of the upper extremity arteries had DM. The remaining patients had normal forehand arterial circulation. A persistent median artery with the absence of radial and ulnar arteries and a high bifurcation of RA from the brachial artery was detected as an anatomic variation in seven patients (12.7%).
Conclusions:
The major advantages of MDCT angiography are its non-invasiveness and the ability to detect calcific subadventitial plaques, which are difficult to diagnose using conventional angiography. MDCT may be used as a safe and non-invasive method to assess RA and UA prior to harvesting the upper limb artery. Preoperative imaging of forehand arteries is a means to avoid unnecessary forearm exploration or the use of an unsuitable arterial conduit in CABG operations, especially in patients with DM and moderate renal impairment.
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