Duplex scanning of the inferior epigastric artery

The inferior epigastric artery (IEGA) has been used as a conduit for coronary artery bypass grafting. Because of varying lengths, diameters, and depths, a method of determining vessel adequacy before operation was needed.

A BioSound Phase II scanner (BioSound, Indianapolis, Ind.) with a 10 MHz probe was used to image the IEGA in 40 patients. Beginning at the common femoral artery and moving superiorly, the external iliac artery is identified with its first branch, which is the IEGA. The IEGA is located deep in the rectus muscle, along the posterior rectus sheath. Frequent measurements of the diameter and depth are taken along the length of the IEGA.

When comparing the group of patients in whom there was operative confirmation of the ultrasound findings, we found, on the right side, a mean length of 9.0 cm and mean diameter of 2.4 mm by ultrasonography and 10.5 mm and 2.4 mm at operation. On the left side the findings were 9.6 cm and 2.6 mm by ultrasonography and 11 cm and 2.6 mm at operation. There was one wound complication in an IEGA harvest site that had a body wall thickness of less than 4 cm (1/23; 4.2%), but all four sites with a body wall thickness of 4 cm or greater developed wound complications (4/4; 100%).

The use of duplex scanning of the IEGA before operation provided excellent information about the length, diameter, depth, and patency of the vessel. Preoperative scanning prevented unnecessary dissection when the IEGA was not of adequate length or diameter. It was also very useful in providing information regarding risk of wound complications in obese patients.