Postoperative flow characteristics of left internal thoracic artery grafts

Nasu, Michihiro; Akasaka, Takashi; Okazaki, Tsuyoshi; Shinkai, M; Fujiwara, Hiroshi; Sono, J; Okada, Yukikatsu; Miyamoto, Satoru; Nishiuchi, S; Yoshikawa, Junichi; Shomura, T

doi:10.1016/0003-4975(94)00795-9

Cited by 59 publications

(35 citation statements)

References 22 publications

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“…7,8) The use of an in situ internal thoracic artery (ITA) for replacing the left anterior descending artery (LAD) has been widely accepted as a standard coronary artery bypass grafting (CABG) strategy that provides long-term patency and improves late survival. [9][10][11][12] However, it has been suggested that mild or moderate stenosis in the LAD is associated with competitive flow, thereby leading to a decreased antegrade flow in the ITA graft, which may lead to graft failure. [13][14][15][16] The purpose of this study was to evaluate the influence of clinical parameters and the degree of LAD stenosis on postoperative ITA graft stenosis, as well as the relationship between postoperative regional ischemia of the LAD territory, as assessed by adenosine thallium-201 myocardial perfusion scintigraphy (Tl-201-MPS), and postoperative ITA graft stenosis using 320-ADCT.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Evaluation of Internal Thoracic Artery Anastomosed to the Left Anterior Descending Artery with 320-Detector Row Computed Tomography and Adenosine Thallium-201 Myocardial Perfusion Scintigraphy

Takagi

Akita

Kondo

et al. 2012

ATCS

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Purpose: We evaluated the relationship between internal thoracic artery (ITA) stenosis anastomosed to the left anterior descending artery (LAD) and the degree of LAD stenosis using 320-detector row computed tomography (320-ADCT) and adenosine thallium-201 myocardial perfusion scintigraphy (Tl-201-MPS). Methods: We included 101 patients who underwent coronary artery bypass grafting (CABG) using ITA grafts; 320-ADCT and adenosine Tl-201-MPS were performed 2-3 months after CABG. Clinical parameters, degree of LAD stenosis, and regional myocardial ischemia of the LAD territory were compared between patients without ITA stenosis (Group A) and with ITA stenosis (Group B). Results: Thirty patients (30%) had ≤75% LAD stenosis, and 9 patients (30%) showed significant ITA stenosis. Regional ischemia was noted in 23 patients (23%). There were no differences in clinical parameters between the 2 groups. Twenty-two patients (24%) in Group A and 8 patients (89%) in Group B had ≤75% LAD stenosis (P <0.002). No Group B patients had regional myocardial ischemia of the LAD territory. Conclusion: We concluded that ≤75% LAD stenosis significantly influences ITA stenosis, without associated regional myocardial ischemia of the LAD territory. Non-invasive 320-ADCT and adenosine Tl-201-MPS for ITA evaluation may be useful for long-term follow-up of patients after CABG. Keywords: internal thoracic artery stenosis, coronary artery bypass grafting, left anterior descending artery stenosis, 320-detector row computed tomography, adenosine thallium-201 myocardial perfusion scintigraphy Ann

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Section: Introductionmentioning

confidence: 99%

Non-invasive Evaluation of Internal Thoracic Artery Anastomosed to the Left Anterior Descending Artery with 320-Detector Row Computed Tomography and Adenosine Thallium-201 Myocardial Perfusion Scintigraphy

Takagi

Akita

Kondo

et al. 2012

ATCS

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“…Doppler studies suggested that a moderate stenosis in the target vessel is associated with competitive flow, thereby leading to a decreased anterograde flow in the arterial graft, which may lead to early failure ("disuse atrophy"). 8 However, the clinical importance of this process remains controversial. Canine experiments have shown that arterial conduits grafted on fully patent native arteries remained patent.…”

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confidence: 99%

Long-Term Patency of Internal Mammary Artery Bypass Grafts

et al. 2004

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Background-Internal mammary artery conduits (IMA) have an excellent long-term patency rate. Nevertheless, graft closure does occur and significantly limits future revascularization options. We sought to investigate the relationship between the long-term patency of IMA with clinical and angiographic parameters. Particularly, the preoperative degree of stenosis of the relevant bypassed coronary vessel was assessed to analyze the importance of chronic competitive flow on the arterial graft closure rate. Methods and Results-Consecutive patients in whom occlusion of at least 1 IMA had been documented at angiography (OCC group) were compared with a group of patients with patent IMA grafts (PAT group). The degree of stenosis in the native coronary artery on which the IMA was placed was analyzed by off-line quantitative coronary angiography. Multivariate stepwise logistic regression was used to identify independent clinical and angiographic predictors of occlusion. The OCC group comprised 96 patients (67Ϯ10 years) with 103 native bypassed arteries analyzed. The PAT group comprised 127 patients (69Ϯ8 years) with 170 native bypassed arteries analyzed. Both groups were similar except for gender (42% versus 32% female; Pϭ0.04), height (166Ϯ8 versus 169Ϯ8 cm; Pϭ0.006), minimum lumen diameter (0.76Ϯ0.7 versus 0.51Ϯ0.5; Pϭ0.001), and diameter stenosis of the native artery (73Ϯ25% versus 84Ϯ16%; PϽ0.0001) in OCC versus PAT, respectively. In the multivariate analysis, only percent diameter stenosis was an independent and statistically significant predictor for graft patency. Among IMA placed on coronary arteries with a diameter of stenosis Ͻ50% (nϭ28), the occlusion rate was very high (79%). Conclusion-The

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“…There was no difference in total flow among the three segments studied [22]. The ITA graft when anastomosed to the coronary artery is submitted to a diastolic blood flow pattern with modulation of the cellular and humoral components of the graft.…”

Section: Discussionmentioning

confidence: 79%

<![CDATA[<B>Sequential histomorphometric study of the left internal thoracic artery</B>]]>

Kneubil¹,

Gomes²,

Aquino³

et al. 2006

Braz. j. cardiovasc. surg.

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Objective: The use of left internal thoracic artery (LITA) in coronary artery bypass surgery is currently recognized as the best option, providing lower incidences of cardiovascular events and superior long-term survival. Now, incremental utilization of these grafts makes a reassessment of its histological structure necessary. Therefore, the purpose of this study was to examine and compare the sequential histological structure of LITA.Method: Specimens of LITA harvested from 18 cadavers, divided into nine proportional segments, were studied. Cuts of each segment were stained by the Verhoeff-Van Gieson technique. The following parameters were analyzed: perimeter of the arterial lumen, thickness of the intima, thickness of the media layer, amount of elastic fiber in the media layer and the elastic fiber density.Results: The collected data showed that perimeter of the LITA decreases downstream on its course, the thickness of the intima is increased in the proximal segments, the thickness of the media layer diminishes throughout its extension, the number of elastic fibers is concentrated in the intermediate segments and the density of elastic fibers is reduced in the proximal and distal segments. Conclusion:Therefore, the findings of the present study validate the heterogeneity of the LITA sequential histological structure. Descriptors

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Postoperative flow characteristics of left internal thoracic artery grafts

Cited by 59 publications

References 22 publications

Non-invasive Evaluation of Internal Thoracic Artery Anastomosed to the Left Anterior Descending Artery with 320-Detector Row Computed Tomography and Adenosine Thallium-201 Myocardial Perfusion Scintigraphy

Non-invasive Evaluation of Internal Thoracic Artery Anastomosed to the Left Anterior Descending Artery with 320-Detector Row Computed Tomography and Adenosine Thallium-201 Myocardial Perfusion Scintigraphy

Long-Term Patency of Internal Mammary Artery Bypass Grafts

<![CDATA[<B>Sequential histomorphometric study of the left internal thoracic artery</B>]]>

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