The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts

Abstract

Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):317-24 Gaiotto FA, et al. -The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts RBCCV 44205-1476 DOI: 10.5935/1678 The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts Ramo descendente da artéria circunflexa lateral femoral é boa opção para revascularização do miocárdio com enxertos arteriais ORIGINAL ARTICLE Abstract Introduction:The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting.Objective: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography.Methods: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7 th and 90 th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05).Results: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001).Conclusion: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory. Descriptors:Tomography. Myocardial revascularization. Coronary disease. 318Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):317-24 Gaiotto FA, et al. -The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts RevThe first case in which the DLFCA was used as a graft in CABG was performed in Japan and was reported by Tatsumi et al. [13], in 1996, when the DLFCA was us...

The descending branch of the lateral circumflex femoral artery as an alternative conduit for coronary artery bypass grafting: Experience from an anatomical, radiological and histological study

“…Interestingly, the experience of Sakakibara et al () suggested that larger caliber DBLCFAs could be of greater importance as collateral channels and therefore should be rather saved and not harvested. Moreover, Gaiotto et al () found a high patency rate and positive luminal adaptation when they used the DBLCFA in 32 patients with CABG, but owing to a high incidence of anatomical variations they suggested that preoperative femoral angiographic examination was mandatory. However, this would be difficult in patients suffering from overall atherosclerosis, which often entails deterioration of kidney function, and patients with severe kidney problems may be unsuited for CTA.…”

“…The DBLCFA is not universally usable as it was not available in 27% of the patients and requires CTA beforehand. The graft might be inappropriate for use in a high percentage of patients (19%) owing to anatomical variations such as short length, narrow lumen diameter, and silent atherosclerosis (Gaiotto et al, ). Another drawback is that the DBLCFA is a muscular limb artery classified as more prone to vasospasm because of its greater sensitivity to circulating catecholamines and other vasoconstrictors than more elastic conduits (e.g.…”

Unusual disposition of lateral circumflex femoral artery: Anatomical description and clinical implications

“…Preoperative anatomical assessment of LCFA through arteriographic study is also essential. The LCFA is frequently explored for its use as new arterial graft for coronary artery bypass grafting [12] . During such surgical procedures, an atypical course of LCFA may lead to an unfortunate sequel of injury to branches of femoral nerve traversing in front of LCFA.…”

Anatomical Variations of ProfundaFemoris Artery in Indian Population

“…The branches of PFA are also used as long vascular pedicle during breast reconstruction after mastectomy in cases of carcinoma of breast. [7,8,9] Bergman et al describe that various vessel of the profunda complex may more or less dissociate, one or another of them having an independent origin from the femoral artery; this may occur to such an extent that a profunda femoris as a definite vessel may not exist. Differing patterns of the origin of the PFA and its branches have been described on a racial basis as well as variations being noted between the two legs of the same individual.…”