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Pedicled arterial grafts in coronary surgery: postoperative echo color-Doppler study
M Agrifoglio1, S Di Matteo, C Antona
1Department of Cardiac Surgery, University of Milan, Italy.
Insights
Mid-term assessment of coronary artery bypass grafts using echo color-Doppler ultrasound shows excellent graft patency. This noninvasive technique reliably evaluates left and right internal mammary arteries and right gastroepiploic artery function post-surgery.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Ultrasound
Background:
- Coronary artery bypass grafting (CABG) frequently utilizes arterial conduits like the left internal mammary artery (LIMA), right internal mammary artery (RIMA), and right gastroepiploic artery (RGEA).
- Postoperative assessment of arterial graft patency is crucial for long-term myocardial revascularization success.
Purpose of the Study:
- To evaluate the efficacy of mid-term postoperative echo color-Doppler ultrasound in assessing the function of pedicled arterial conduits used in coronary surgery.
- To compare the diagnostic accuracy of echo color-Doppler ultrasound with postoperative angiography for arterial graft patency.
Main Methods:
- A mid-term postoperative echo color-Doppler ultrasound was performed on 31 patients who underwent complete arterial myocardial revascularization.
- Seventy-one pedicled arterial grafts (31 LIMA, 15 RIMA, 25 RGEA) were analyzed for Doppler spectrum, diameter, and flow.
- Postoperative angiography was performed in 27 patients to corroborate ultrasound findings.
Main Results:
- Echo color-Doppler ultrasound achieved 100% detection of all studied arterial grafts, identifying Doppler spectrum, diameter, and flow.
- All conduits demonstrated good diastolic and end-diastolic velocities, indicating normal graft patency.
- Angiography confirmed 100% patency for all arterial grafts and anastomoses in the evaluated patients, correlating well with Doppler findings.
Conclusions:
- Echo color-Doppler ultrasound is a promising, noninvasive, safe, and efficient method for serial postoperative assessment of arterial graft function (LIMA, RIMA, RGEA) in coronary surgery.
- Preliminary results indicate satisfactory agreement between echo color-Doppler ultrasound and angiography in evaluating conduit patency.
Abstract:
In 1994 a mid-term postoperative echo color-Doppler ultrasound was performed to check the pedicled arterial conduits used in coronary surgery, such as the left and right internal mammary arteries (LIMA, RIMA) and the right gastroepiploic artery (RGEA). This evaluation was made in 31 patients with a previous nonemergent complete arterial myocardial revascularization. The pedicled arterial grafts studied were 71 (31 LIMA, 15 RIMA and 25 RGEA). The Doppler spectrum (combined systolic/diastolic waveform), the diameter and the flow of every arterial graft was always identified (100% of detection) and there was a statistical significative difference between mean RGEA flow versus mean LIMA and RIMA flow (p<0.05). All the conduits studied were characterized by a good diastolic and end-diastolic velocity, evidence of normal graft patency. The postoperative angiogram of the LIMA, RIMA and RGEA conduits was performed in 27/31 (87.1%) patients and it showed 100% patency of arterial grafts used and of anastomoses. The echo color-Doppler data were compared to postoperative angiographic results. The echo color-Doppler imaging of the pedicled arterial grafts used in coronary surgery seems to be a promising technique for the postoperative serial assessment of the LIMA, RIMA and RGEA conduit function, because it is noninvasive, safe, easy, quick to perform and the preliminary results of echo color-Doppler ultrasound versus angiography are satisfactory.