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Doppler Ultrasound Selection and Follow-Up of the Internal Mammary Artery as Coronary Graft
Pietro Scicchitano1, Micaela De Palo2, Giuseppe Parisi3
1Department of Cardiology, Hospital 'F. Perinei' Altamura, 70022 Altamura, Italy.
Insights
Doppler ultrasonography (DU) offers a reliable, non-invasive method for assessing left internal mammary artery (LIMA) graft patency after coronary artery bypass grafting (CABG). This technique aids in detecting significant stenosis, improving patient follow-up care.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Coronary artery disease (CAD) significantly impacts mortality and disability.
- Coronary revascularization, particularly coronary artery bypass grafting (CABG), improves outcomes in atherosclerosis patients.
- Left internal mammary artery (LIMA) grafts are highly effective in CABG but challenging to assess non-invasively.
Purpose of the Study:
- To evaluate the effectiveness of Doppler ultrasonography (DU) in assessing LIMA graft patency.
- To review the impact of DU on follow-up care for patients post-CABG.
- To explore DU's capability in detecting LIMA graft stenosis.
Main Methods:
- Narrative review of existing literature on Doppler ultrasonography for LIMA graft assessment.
- Analysis of DU parameters for identifying significant LIMA stenosis (e.g., velocity ratios, diastolic fraction).
- Consideration of stress testing combined with DU for patency evaluation.
Main Results:
- Doppler ultrasonography demonstrates potential as a reliable non-invasive tool for LIMA graft patency assessment.
- DU can identify severe (>70%) LIMA stenosis using specific Doppler parameters.
- Combined stress testing and DU may enhance patency evaluation.
Conclusions:
- Doppler ultrasonography is a valuable technique for non-invasive LIMA graft patency assessment post-CABG.
- DU findings can guide clinical decisions in managing patients with potential graft issues.
- Further research can solidify DU's role in routine LIMA graft surveillance.
Abstract:
The impact of coronary artery disease (CAD) on all-cause mortality and overall disabilities is well-established. Percutaneous and/or surgical coronary revascularization procedures dramatically reduced the occurrence of adverse cardiovascular events in patients suffering from atherosclerosis. Specifically, guidelines from the European Society of Cardiology on the management of myocardial revascularization promoted coronary artery by-pass graft (CABG) intervention in patients with specific alterations in the coronary tree due to the higher beneficial effects of this procedure as compared to the percutaneous one. The left internal mammary artery (LIMA) is one of the best-performing vessels in CABG procedures due to its location and its own structural characteristics. Nevertheless, the non-invasive assessment of its patency is challenging. Doppler ultrasonography (DU) might perform as a reliable technique for the non-invasive evaluation of the patency of LIMA. Data from the literature revealed that DU may detect severe (>70%) stenosis of the LIMA graft. In this case, pulsed-wave Doppler might show peak diastolic velocity/peak systolic velocity < 0.5 and diastolic fraction < 50%. A stress test might also be adopted for the evaluation of patency of LIMA through DU. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow-up after CABG intervention.
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