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Abdominal aorta and visceral arteries visualized by transgastric echocardiography: technical considerations
K Orihashi1, Y Matsuura, T Sueda
1First Department of Surgery, Hiroshima University School of Medicine, Japan. ka-ori@mcai.med.hiroshima-u.ac.jp
Insights
Transesophageal echocardiography (TEE) can visualize the abdominal aorta and visceral arteries during surgery. While effective for the celiac and superior mesenteric arteries, renal artery visualization is limited but can be improved with specific techniques.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Echocardiography
Background:
- Intraoperative visualization of the abdominal aorta and visceral arteries is crucial for cardiovascular surgery.
- Currently, no definitive intraoperative modality exists for assessing these vessels.
Purpose of the Study:
- To evaluate the feasibility and limitations of transesophageal echocardiography (TEE) for intraoperative visualization of the abdominal aorta and visceral arteries.
Main Methods:
- Transesophageal echocardiography (TEE) was performed on 21 consecutive patients undergoing cardiovascular surgery.
- Specific probe manipulations were employed to optimize visualization of the celiac artery (CEA), superior mesenteric artery (SMA), and left and right renal arteries (LRA, RRA).
Main Results:
- The CEA and SMA were visualized in 100% and 95.2% of cases, respectively.
- The LRA and RRA visualization rates were 66.7%, with repeated attempts and specific probe manipulations improving success.
- Limitations included inferior visualization of renal arteries, addressed by repeated attempts or color Doppler imaging of renal parenchyma.
Conclusions:
- Transesophageal echocardiography (TEE) is a feasible modality for visualizing the abdominal aorta and visceral arteries during surgery, particularly the CEA and SMA.
- Visualization of the renal arteries presents challenges but can be enhanced with specific techniques and experienced sonographers.
- Caution is advised due to potential gastric wall damage, recommending experienced personnel for TEE procedures.
Abstract:
Despite the necessity of information regarding the abdominal aorta and visceral arteries during cardiovascular surgery, there has been no intraoperative modality available. We examined the feasibility and limitations of transesophageal echocardiography (TEE) for this purpose. In 21 consecutive patients, the celiac artery (CEA), superior mesenteric artery (SMA), and left and right renal arteries (LRA, RRA) were examined with TEE, and could be visualized in 21 cases (100%), 20 cases (95.2%), 14 cases (66.7%) and 14 cases (66.7%), respectively. Several attempts were needed for successfully visualizing the LRA and the RRA in 2 and 1 case(s), respectively. Three specific manipulations of the probe were helpful for visualizing these vessels: 1) an appropriate counterclockwise rotation and an upward flexion of the probe when the transducer entered the stomach; 2) a stiffening of the flexible portion of the probe at the position of upward flexion by fixing the handle of the TEE probe when the transducer was advanced; and 3) a lateral flexion of the probe to provide a rotation of the image in either the clockwise or counterclockwise direction and to optimize the assessment of the blood flow velocity in the branch artery. Inferior visualization of the renal arteries was a limitation of this method. Two solutions for this problem were 1) repeated attempts at visualization and 2) an examination of the blood flow in the renal parenchyma with color Doppler imaging. Because of possible damage to the gastric wall, it is recommended that this maneuver be conducted by an experienced sonographer.