Related Experiment Videos
Gastroepiploic artery coronary bypass graft: non-invasive patency evaluation using color and duplex Doppler
S Gryspeerdt1, L Van Hoe, L Mertens
1Department of Radiology, University Hospitals, Leuven, Belgium.
Insights
Ultrasound is proposed as a primary screening tool for evaluating gastroepiploic artery (GEA) graft patency. Spectral analysis, calculating the coronary resistance index (cRI), is crucial for assessing graft function.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Ultrasound
Background:
- Graft patency is critical for the success of coronary artery bypass grafting.
- Accurate and efficient evaluation of gastroepiploic artery (GEA) graft patency is essential.
Purpose of the Study:
- To compare the efficacy of color and duplex Doppler ultrasound with digital subtraction angiography (DSA) in evaluating GEA graft patency.
- To determine the role of ultrasound in assessing GEA graft function.
Main Methods:
- Seventy-seven GEA observations were analyzed, comparing ultrasound findings with DSA.
- The coronary resistance index (cRI) was calculated using spectral Doppler analysis.
- Graft status was categorized by DSA as patent, occluded, or patent but non-functional.
Main Results:
- Ultrasound identified the GEA in 65 out of 77 observations with no false positives.
- A cRI > 0.60 accurately identified sonographically detected non-functional grafts (n=7).
- Using a cRI cutoff of 0.60, sensitivity and specificity for detecting non-functional or occluded grafts were 100% and 75%, respectively.
Conclusions:
- Ultrasound, particularly color and duplex Doppler, is proposed as a primary screening tool for GEA graft patency.
- Spectral analysis and calculation of the cRI are necessary for functional evaluation of GEA grafts.
- Ultrasound offers a valuable, non-invasive method for assessing bypass graft viability.
Objective:
Color and duplex Doppler ultrasound and digital subtraction angiography were compared for the evaluation of graft patency of the gastroepiploic artery (GEA).
Methods:
In 77 observations, ultrasound and digital subtraction angiography were compared. The coronary resistance index (cRI) was defined as the maximal systolic flow velocity minus the maximal diastolic flow velocity, divided by the maximal systolic flow velocity. On digital subtraction angiography, the graft was considered patent, occluded, or patent but non-functional. Grafts were defined as non-functional when they had a diameter of less than 5F with the absence of opacification of the native coronary artery.
Results:
Of the 77 observations, 64 GEAs were patent angiographically, three were occluded and ten grafts were considered as patent but non-functional. Using color and duplex ultrasound, the GEA was identified in 65 out of 77 observations. There were no cases of false positive visualization of the GEA. All sonographically detected non-functional grafts (n = 7) had a cRI of greater than 0.60. When the non-visualized grafts are considered either non-functional or occluded, a cut-off value for a cRI of 0.60 results in a sensitivity and specificity of 100 and 75%, respectively.
Conclusion:
We propose ultrasound as a primary screening tool for evaluating graft patency. While color Doppler is a suitable technique for graft visualization, spectral analysis with the calculation of a cRI is required for functional evaluation.