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

Abstract

The descending branch of the lateral circumflex femoral artery (DBLCFA) has been suggested as an option for use in coronary artery bypass grafting (CABG). Our aim was to combine radiological examination, surgical and anatomical preparation, and histological assessment of the DBLCFA to map its variability and to assess the benefits of this conduit in cardiac surgery. The pelvic and femoral arteries were examined by CT angiography (CTA) in 100 patients (aged 68.3 ± 9.3 years) to assess the variability of the DBLCFA. Anatomical dissections were performed on 20 cadavers. In 15 patients, an autologous DBLCFA was implanted during CABG. In 35 samples, possible atherosclerotic lesions were examined histologically. The length of the potential DBLCFA conduits measured by CTA was 9.3 ± 2.9 cm, without correlating with the length of the thigh. Anatomical variations that would prevent the DBLCFA from being used in CABG were found in 27 out of 100 patients. Except for focal thickening of the intima, eccentric hypertrophy of the intima was found in three out of 35 samples. No inflammatory infiltration, foam cells, atheroma, or calcifications were found histologically. The DBLCFA is not to be used routinely or in preference to other grafts of choice. However, owing to its moderate variability, sufficient length, caliber, and rare atherosclerosis, it can be used in the absence of other suitable grafts as an alternative conduit implanted as a composite Y-graft end-to-side to the internal thoracic artery in patients without diabetic angiopathy, neuropathy or peripheral artery disease who are undergoing extensive or repeat coronary revascularization. Clin. Anat. 29:779-788, 2016. © 2016 Wiley Periodicals, Inc.

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

“…Anatomically, the DLCFA is a relatively large artery, typically 2-3 mm in diameter, and has an average potential conduit length of approximately 12-15 cm. [31][32][33] In addition, unlike the RA, the DLCFA tends to taper less and maintains a relatively consistent vessel diameter, which provides predictable donor and recipient vessel size match. Moreover, unlike the RA, the DLCFA is less prone to atherosclerotic changes.…”

“…[34][35][36] Studies of coronary artery bypass grafting using the DLCFA also demonstrate excellent patency rates and a low incidence of vasospasm. 31,37 From a patient's perspective, the DLFCA is aesthetically appealing because its harvest site is commonly covered. It is also a functionally favorable donor site, with harvest site complications unlikely to affect extremity function as can happen with nerve or tendon injuries during RA harvest.…”

Myocardial revascularization using the posterior intercostal arteries as grafts: anatomical variation aspect

“…The anatomical criteria of using arterial conduits include simple accessibility, a proper length to reach the targeted arteries, a suitable caliber, and compatible histological structures to the coronary vessels (19). Since the ITA is most often used for CABG, all other potentially appropriate arteries must be compatable with the majority of its characteristics.…”

“…Anatomical variations of the course could also limit the potential use of a particular PIA as an in situ graft when creating a pedicle. Results of a study that mapped the variabi-lity of the descending branch of the lateral circumflex femoral artery as a conduit for CABG concluded that even moderate morphological variations were not possible in 27% of potential vessels, as demonstrated by computed tomography angiography (19).…”

Khảo sát mạch nuôi vạt cơ rộng ngoài ở người Việt trưởng thành qua chụp cắt lớp vi tính 320 dãy

“…Huang KC (2015) [5] lưu ý chống chỉ định sử dụng vạt cơ rộng ngoài cải biên (lấy cả phần cân-da kèm theo cơ) nếu không khảo sát thấy nhánh xuống của động mạch mũ đùi ngoài. Guillermo E. Artero (2018) [4] nghiên cứu trên 11 bệnh nhân chuyển vạt da cân cơ rộng ngoài hai bên, sau đó nghiên cứu trên 7 xác để khẳng định và chụp mạch, tác giả thấy sự phân bố nhánh của nhánh xuống đông mạch mũ đùi ở hai bên không giống nhau 100%, vì vậy việc khảo sát mạch bằng chụp cắt lớp trước mổ là cần thiết, giúp làm ngắn thời gian phẫu thuật Pert Loskot (2016) [8], nghiên cứu chụp mạch nhánh xuống của động mạch mũ đùi ngoài trên 100 bệnh nhân, tuổi trung bình 68,3 ± 9,3 tuổi, kết quả cho thấy chiều dài trung bình của mạch là 9,3 ± 2,9cm (2,1cm-17,4cm) và không liên quan với chiều dài của đùi, tác giả tính chiều dài từ nguyên ủy cho đến khi phân nhánh vào cơ, hoặc đo đường kính 2mm tại thân động mạch. Đường kính mạch tại nguyên ủy trung bình 2,9mm.…”