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Non-invasive evaluation of right gastroepiploic artery with colour Doppler echography
M Agrifoglio1, S Di Matteo, A Parolari
1Department of Cardiac Surgery, University of Milan, Italy.
Insights
Echo-colour Doppler is a safe, non-invasive method to assess the patency of right gastroepiploic artery grafts used in coronary artery bypass surgery. This technique accurately identifies graft status, aiding long-term patient follow-up.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Grafts
Background:
- The right gastroepiploic artery (RGEA) is increasingly utilized as a coronary bypass graft.
- While short- and mid-term patency are promising, long-term data remain limited.
- Conclusive evidence on the long-term efficacy of RGEA grafts is needed.
Purpose of the Study:
- To evaluate the efficacy of echo-colour Doppler for assessing the patency of RGEA grafts.
- To establish Doppler parameters indicative of RGEA graft patency and flow capacity.
- To compare Doppler findings with angiographic results in a postoperative setting.
Main Methods:
- A reference group (n=24) with confirmed 100% patent RGEA grafts underwent postoperative angiography.
- A second group (n=89) was assessed using echo-colour Doppler during the postoperative period (mean 8.0 months).
- Doppler parameters including velocity patterns, peak systolic/diastolic velocities, diameter, and flow were analyzed.
Main Results:
- A patent RGEA graft demonstrated a biphasic velocity pattern with specific ranges for systolic/diastolic peak velocities, diameter, and flow.
- Three patients in the Doppler group were suspected of graft occlusion.
- Angiography confirmed graft closure in all three suspected cases, validating Doppler's accuracy.
Conclusions:
- Serial echo-colour Doppler evaluation is a non-invasive and safe method for monitoring RGEA graft patency.
- This technique effectively assesses graft patency and flow capacity in follow-up studies.
- Echo-colour Doppler provides reliable data for long-term surveillance of RGEA coronary grafts.
Abstract:
The right gastroepiploic artery has been increasingly used as a coronary bypass graft. Short- and mid-term patency rates support the supposition that the right gastroepiploic artery is a satisfactory bypass conduit. However, conclusive angiographic data on long-term patency rates are still lacking. An echo-colour Doppler method was used to detect patency of the right gastroepiploic artery grafts through an upper abdominal approach. A group of 24 patients with a right gastroepiploic artery graft to the right or posterior descending coronary artery, all of whom also had a postoperative angiographic study which showed 100% patency of the graft were used as a reference group. A second group of 89 patients was also investigated only with echo-colour Doppler during the postoperative period (mean 8.0 (range 1-48) months). A patent right gastroepiploic artery graft showed a biphasic velocity pattern. Systolic peak velocity ranged from 8 to 26 cm and diastolic peak velocity from 4 to 13 cm. The right gastroepiploic artery diameter ranged from 1.7 to 2.4 mm and flow from 10.2 to 58.8 ml. Among the second group were three patients who had, at their echo-colour Doppler examination, a possible occlusion of the right gastroepiploic artery graft; an angiographic study was conducted and the graft closure confirmed in all cases. Serial echo-colour Doppler evaluation of the right gastroepiploic artery blood flow pattern and diameter is a non-invasive and safe method to check the patency and flow capacity of the artery graft in follow-up studies.