Transcutaneous ultrasound assessment of internal thoracic artery to coronary artery grafts in patients with and without ischaemic symptoms.

Abstract

The left internal thoracic artery is now accepted as the conduit of choice for surgical revascularisation of the left anterior descending coronary artery and, with some reservations, other accessible coronary vessels. 1-3 We have previously described the use of transcutaneous duplex ultrasound in imaging the proximal part of the grafted internal thoracic artery and have related the estimated graft bloodflow to "runoff' in the graft territory.4-5 Several other groups have reported similar or complementary techniques and results.6-8 We report here the range of ultrasound findings in a prospective series of consecutive patients undergoing left internal thoracic artery grafting, and attempt to correlate ultrasound and angiographic findings in patients with suspected recurrent ischaemia after grafting. Our objectives were to define the range of "normality" of ultrasound graft measurements and to identify possible patterns which correlate with graft malfunction.Patients and methods Eighty three consecutive patients operated on by a single surgeon (TJS) were identified from operating lists and invited to attend for outpatient ultrasound assessment. They were interviewed by a doctor to ensure they were free from anginal symptoms. Patients rested supine for at least 20 minutes before examination. Examinations were performed at least two hours after any meal. Patients continued to take their usual drugs on the day of the study. Sixteen patients with 18 internal thoracic artery grafts presenting to our service over the same period with suspected recurrent ischaemia after previous internal thoracic artery grafting underwent a duplex ultrasound examination followed by angiography. Coronary and graft angiography were performed by standard techniques from a femoral approach using 7FG catheters.The technique of duplex ultrasound assessment was as previously described.4-5 A Diasonics (Bedford, United Kingdom) ultrasound system (Diasonics Spectra) was used with a 5 MHz linear array probe and colourflow Doppler facility. The upper left parasternal and supraclavicular transducer positions were used. The colourflow facility was used to identify the origin of the internal thoracic artery as it arose from the first part of the subclavian artery. The diameter of the vessel was measured with the transducer as near to 476 on 7 June 2019 by guest. Protected by copyright.

Does Doppler echography have a diagnostic role in patency assessment of internal thoracic artery grafts?

“…Fifteen articles [27][28][29][30][31][34][35][36][38][39][40][41][44][45][46] published in English produced 20 results (Table 4). Sensitivity, specificity, DOR, and AUC were higher than the overall data group.…”

“…The remainder of the studies [27][28][29]31,36,37,40,42,44,46] used other criteria for diagnosing graft stenosis.…”

“…No attempts at author contact were made. The verification bias in some studies was high [28], or difficult to assess [29,32,[40][41][42][43]46] contributing to reporting bias. Graft detection performance varied between studies, ranging from less than 50 up to 100%.…”

“…Eighteen papers were excluded in total for various reasons: repetition of data [9,10], insufficient data reporting [11][12][13], intraoperative TDE data [14][15][16], lack of patency assessment [17][18][19][20][21][22] and inclusion of patent grafts only [23][24][25][26]. The remaining 20 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] were included for analysis after extraction of study characteristics (Table 1).…”

“…Thus, in most of the studies, verification bias was small (Table 1). However, in some studies no information was given regarding recruitment process or criteria for undergoing CA and TDE [29,32,[40][41][42][43]46]. …”