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[Description of arterial grafts from the aspect of preoperative angiography]
1Department of Cardiovascular Surgery, Koseiren Hiroshima General Hospital, Japan.
Insights
Preoperative angiography revealed the right gastroepiploic artery (RGEA) is significantly larger than bilateral internal thoracic arteries (ITA) for coronary revascularization. This finding offers valuable insights for arterial graft selection in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Anatomy
Background:
- Bilateral internal thoracic arteries (ITA) and right gastroepiploic artery (RGEA) are increasingly used in coronary revascularization.
- Preoperative angiographic data for these arterial grafts are scarce.
Purpose of the Study:
- To perform preoperative angiography of ITA and RGEA grafts.
- To compare the diameters of these arterial grafts.
Main Methods:
- Preoperative angiography was performed on 68 arterial grafts (ITA and RGEA) in 24 patients.
- Graft diameters were measured at specific proximal, central, and bifurcation points.
Main Results:
- The right gastroepiploic artery (RGEA) demonstrated the largest proximal diameter (2.78 mm), followed by the right internal thoracic artery (RITA) (2.59 mm) and left internal thoracic artery (LITA) (2.08 mm).
- RGEA also showed the largest diameter at expected anastomosis sites, with RITA tending to be larger than LITA.
- Arterial occlusion was found in 2 grafts, and arteriostenosis in 1 graft.
Conclusions:
- The RGEA is significantly larger than ITA grafts, particularly at proximal and anastomosis sites.
- Preoperative assessment of arterial graft diameters, including RGEA and ITA, is crucial for optimizing coronary revascularization.
- Findings suggest potential advantages of RGEA over ITA in certain anatomical contexts.
Abstract:
Bilateral internal thoracic arteries (ITA) and right gastroepiploic artery (RGEA) have come into more frequent use of late in coronary revascularization. Angiography of these arterial grafts, however, is performed only postoperatively in almost all patients. There have, so far, been no reports giving a preoperative angiographic description of each arterial graft. In this paper, we describe a study in which we performed preoperative angiography of ITA and RGEA and made a comparison of various grafts, which yielded interesting findings. Twenty-four patients (68 arterial grafts) who were judged to need surgery were performed preoperative angiography of the grafts. The diameter of ITA was measured at three points--the proximal part (Prox), center (Cent) and bifurcation of the artery near the rectus abdominal muscle (Bif). The diameter of RGEA was measured at two points--the proximal part and at 1/2 of the greater curvature of the stomach (Mid). The graft diameter of RGEA was 2.78 mm and significantly the largest, followed by RITA (2.59 mm) and LITA (2.08 mm), when the diameters of the proximal parts of the grafts were compared. Comparison of the diameters of RGEA-Mid and ITA-Bif, which were expected to be the anastomosis sites, also showed that RGEA was significantly the largest, and that the right ITA tended to be larger than the left ITA. Of the 24 patients, 68 arterial grafts, on which angiography was performed, 2 patients were found to have arterial occlusion and 1 to have arteriostenosis.(ABSTRACT TRUNCATED AT 250 WORDS)