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Elwali A, Moussavi Z. The modified Allen test and a novel objective screening algorithm for hand collateral circulation using differential photoplethysmography for preoperative assessment: a pilot study. J Med Eng Technol 2020; 44:82-93. [DOI: 10.1080/03091902.2020.1723729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ahmed Elwali
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
- Electrical and Computer Engineering Department, University of Manitoba, Winnipeg, Canada
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2
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Carrel T, Winkler B. Current trends in selection of conduits for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2017; 65:549-556. [DOI: 10.1007/s11748-017-0807-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/31/2017] [Indexed: 01/16/2023]
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Martínez-González B, Reyes-Hernández CG, Quiroga-Garza A, Rodríguez-Rodríguez VE, Esparza-Hernández CN, Elizondo-Omaña RE, Guzmán-López S. Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies. Ann Thorac Cardiovasc Surg 2017; 23:55-65. [PMID: 28202895 DOI: 10.5761/atcs.ra.16-00178] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a significant variety of vascular conduits options for coronary bypass surgery. Adequate graft selection is the most important factor for the success of the intervention. To ensure durability, permeability, and bypass function, there must be a morphological similarity between the graft and the coronary artery. The objective of this review was to analyze the morphological characteristics of the grafts that are most commonly used in coronary bypass surgery and the coronary arteries that are most frequently occluded. We included clinical information regarding the characteristics that determine the behavior of the grafts and its permeability over time. Currently, the internal thoracic artery is the standard choice for bypass surgery because of the morphological characteristics of the wall that makes less prone to developing atherosclerosis and hyperplasia. The radial and right gastroepiploic arteries are the following second and third best options, respectively. The ulnar artery is the preferred choice when other conduits are not feasible.
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Affiliation(s)
- Brenda Martínez-González
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Cynthia Guadalupe Reyes-Hernández
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Alejandro Quiroga-Garza
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Víctor E Rodríguez-Rodríguez
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Claudia N Esparza-Hernández
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Rodrigo E Elizondo-Omaña
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
| | - Santos Guzmán-López
- Faculty of Medicine, Human Anatomy Department and University Hospital "Dr. Jose Eleuterio González", Universidad Autonoma de Nuevo León (UANL), Monterrey NL, Mexico
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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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Affiliation(s)
- Norman Eizenberg
- Department of Anatomy & Developmental Biology, Monash University, Melbourne, VIC, Australia
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Head SJ, Kieser TM, Falk V, Huysmans HA, Kappetein AP. Coronary artery bypass grafting: Part 1--the evolution over the first 50 years. Eur Heart J 2014; 34:2862-72. [PMID: 24086085 DOI: 10.1093/eurheartj/eht330] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Surgical treatment for angina pectoris was first proposed in 1899. Decades of experimental surgery for coronary artery disease finally led to the introduction of coronary artery bypass grafting (CABG) in 1964. Now that we are approaching 50 years of CABG experience, it is appropriate to summarize the advancement of CABG into a procedure that is safe and efficient. This review provides a historical recapitulation of experimental surgery, the evolution of the surgical techniques and the utilization of CABG. Furthermore, data on contemporary clinical outcomes are discussed.
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Affiliation(s)
- Stuart J Head
- Department of cardiothoracic surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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He GW. Arterial grafts: clinical classification and pharmacological management. Ann Cardiothorac Surg 2013; 2:507-18. [PMID: 23977630 DOI: 10.3978/j.issn.2225-319x.2013.07.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/16/2013] [Indexed: 01/08/2023]
Abstract
In comparison with standard saphenous vein grafts, use of the internal mammary artery (IMA) as a coronary artery bypass graft has achieved superior long-term results. This is related to the differences in the biological characteristics between the venous and arterial grafts. However, even arterial grafts are not uniform in their biological characteristics. The variation in the perioperative behavior of the grafts and in their long-term patency may be related to different characteristics. These factors should be taken into account in the use of arterial grafts, some of which are subjected to more active pharmacological intervention during and after the operation to obtain satisfactory results. To better understand the biological behavior of the grafts, their common features and their differences, a clinical classification may be useful for a practicing surgeon. Based on experimental studies of their vasoreactivity combined with anatomical, physiological and embryological considerations, we have proposed a functional classification for arterial grafts that may be useful clinically. Our classification suggests that there are three types of arterial grafts: Type I-somatic arteries; Type II-splanchnic arteries; and Type III-limb arteries. Type I arteries have enhanced endothelial function and release more nitric oxide and other relaxing factors. Type II arteries, such as the gastro-epiploic artery, and Type III arteries, such as the radial artery (RA), have higher pharmacological reactivity to vasoconstrictors. This classification explains why the IMA has the best long-term patency. Because Type II and III arteries are prone to spasms due to higher contractility, they require more active pharmacological interventions. Furthermore, the harvesting technique of the conduits, including the saphenous vein and IMA, are described and discussed in this article. Prevention of spasms using two cocktails of medications (verapamil + nitroglycerin and nicardipine + nitroglycerin) during harvesting of the conduits is described. These solutions have been demonstrated to be clinically effective.
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Affiliation(s)
- Guo-Wei He
- TEDA International Cardiovascular Hospital, Tianjin & The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; ; Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Nakazono T, Suzuki M, White CS. Computed tomography angiography of coronary artery bypass graft grafts. Semin Roentgenol 2012; 47:240-52. [PMID: 22657114 DOI: 10.1053/j.ro.2011.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Takahiko Nakazono
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Tan ST, James DW, Moaveni Z. Donor site morbidity of free ulnar forearm flap. Head Neck 2011; 34:1434-9. [DOI: 10.1002/hed.21943] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/16/2011] [Accepted: 08/03/2011] [Indexed: 11/08/2022] Open
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Lu M, Jen-Sho Chen J, Awan O, White CS. Evaluation of Bypass Grafts and Stents. Radiol Clin North Am 2010; 48:757-70. [DOI: 10.1016/j.rcl.2010.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109:1763-81. [PMID: 19923502 DOI: 10.1213/ane.0b013e3181bbd416] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Affiliation(s)
- Marek Brzezinski
- Anesthesiology Service (129) VA Medical Center, 4150 Clement St., San Francisco, CA 94121, USA.
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Rockwell WB, Smith SM, Tolliston T, Valnicek SM. Arterial conduits for extremity microvascular bypass surgery. Plast Reconstr Surg 2003; 112:829-34. [PMID: 12960865 DOI: 10.1097/01.prs.0000070177.63398.3f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- W Bradford Rockwell
- Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA.
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Abstract
BACKGROUND The radial artery is presently widely used as a bypass graft for coronary artery reconstruction. However, the traditional opinion that the ulnar artery is the larger forearm artery has been questioned. METHODS The internal diameters of the radial and ulnar arteries were measured at the wrist in postmortem angiograms of 24 cadavers. Differences in mean values of variables between ulnar and radial arteries were analyzed using the Wilcoxon test. RESULTS The mean diameter of the radial artery was 28% larger than that of the ulnar artery in the right arm (p < 0.001) and 26% larger in the left arm (p < 0.001). In the right arm the radial artery was dominant in 20 of 24 cadavers (83%), the ulnar artery in 3 of 24 (13%), and the arteries were equal in 1 of 24 (4%). In the left arm the figures were 17 of 24 cadavers (71%), 3 of 24 (13%), and 4 of 24 (17%), respectively. CONCLUSIONS In view of the present investigation the radial artery should be considered the larger forearm artery of the hand in most patients.
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Affiliation(s)
- Heikki V Riekkinen
- Department of Thoracic and Vascular Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Nie M, Ohara K, Miyoshi Y, Tsukuda K, Torii S, Yoshimura H. Ulnar artery graft for myocardial revascularization. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:112-4. [PMID: 10769991 DOI: 10.1007/bf03218101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
We present a 60-year-old man who underwent coronary artery bypass grafting using an ulnar artery as one of the grafts intended to release angina pectoris. Previously, his right leg had been amputated following a traffic accident. The blood supply of his left leg was reduced due to atherosclerotic stenotic change (left ankle pressure index 0.6). He had been under treatment for severe diabetes mellitus for 4 years. Coronary angiography revealed severe stenosis in the triple coronary artery system. Immediate myocardial revascularization was considered necessary. We considered that saphenous vein grafts and bilateral internal thoracic artery grafts were unsuitable for this patient. Moreover, Allen's test was positive in the bilateral forearms. Coronary artery bypass surgery consisted of left internal thoracic artery grafting to the left anterior descending artery, right gastroepiploic artery grafting to the right coronary artery, and left ulnar artery grafting to the diagonal branch. No myocardial or hand complications were observed after surgery. Following a review of the Japanese literature, we conclude that our case is the first report of an ulnar artery graft for coronary artery bypass grafting in Japan.
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Affiliation(s)
- M Nie
- Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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He GW. Arterial grafts for coronary artery bypass grafting: biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 1999; 67:277-84. [PMID: 10086578 DOI: 10.1016/s0003-4975(98)01207-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Various arterial grafts have been used for coronary artery bypass grafting, but a unanimous opinion on how to best use these grafts has not been formed. Arterial grafts are not uniform in their biological characteristics. Differences between the perioperative behavior of the grafts and their long-term patency may be related to different characteristics. These characteristics should be taken into account in the use of arterial grafts, some of which are subject to more active pharmacologic intervention during and after operation to obtain satisfactory results. Clinical choice of grafts must be based on the general condition of the patient, the biological characteristics of the graft, the anatomy of the coronary artery, the match between the coronary artery and the graft, and technical considerations, including antispastic management.
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Affiliation(s)
- G W He
- Department of Surgery, University of Hong Kong, Grantham Hospital, Aberdeen.
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