Preoperative ultrasound evaluation of the internal thoracic artery in coronary artery bypass grafting planning

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques Pub Date : 2025-10-01 DOI:10.1016/j.xjtc.2025.06.013

Ting Ren MD, Haoyi Yao MD, Junjie Zhang MD, Xiaofeng Ye MD, PhD, Jiapei Qiu MD, Qiang Zhao MD, PhD

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引用次数: 0

Abstract

Objective

The internal thoracic artery (ITA) is the preferred conduit for coronary artery bypass grafting (CABG) due to its superior long-term patency, so preoperative meticulous evaluation of ITA quality is crucial to optimize surgical outcomes and ensure graft patency. This study employs ultrasound to assess ITA anatomical and functional characteristics, specifically investigating the relationship between ultrasound-derived ITA diameter, peak systolic velocity (PSV), and intraoperative graft flow.

Methods

In this prospective observational study conducted between March 2024 and March 2025, 199 patients scheduled for CABG underwent preoperative ITA ultrasound evaluation and 148 patients undergoing CABG with ITA grafting were included in the final analysis. Preoperative ultrasound measurements of ITA diameter and PSV were recorded at the third, fourth, and fifth intercostal spaces. Multivariable linear regression models were constructed to assess the associations between preoperative ITA ultrasound parameters and intraoperative graft flow, which was measured using the transit-time flow measurement method with a flowmeter.

Results

Examination of the ITA revealed that 98.0% showed no stenosis, whereas mild abnormalities (plaque or mild stenosis) were observed in 1.0%, and 0.8% had a tortuous course. Similarly, 96.7% of subclavian arteries exhibited no stenosis, with moderate stenosis in 2.0% and severe stenosis or occlusion in 1.3%. Among vertebral arteries, only 3.5% displayed severe stenosis or occlusion. After adjusting for various confounding factors, PSV at the fourth intercostal space was significantly associated with intraoperative ITA graft flow (β = .399, 95% CI 0.109-0.689; P = .007). Furthermore, after adjusting for age, PSV ≥65.0 cm/s seemed significantly predicted better ITA grafts flow (β = 10.527; P = .040), with a significant linear trend observed (P for trend = .039).

Conclusions

Preoperative ITA ultrasound, as a convenient, cost-effective, and noninvasive method, can be used for evaluating the ITA before surgery, thereby improving surgical outcomes in CABG.

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胸廓内动脉在冠状动脉旁路移植术中的术前超声评价

目的胸内动脉（ITA）具有良好的长期通畅性，是冠状动脉旁路移植术（CABG）的首选导管，因此术前对ITA质量进行细致评估对优化手术效果和保证移植通畅至关重要。本研究采用超声评估ITA的解剖和功能特征，特别探讨超声衍生ITA直径、峰值收缩速度（PSV）和术中移植物流量之间的关系。方法本前瞻性观察研究于2024年3月至2025年3月进行，199例计划行CABG的患者术前行ITA超声评估，148例行CABG合并ITA移植的患者纳入最终分析。术前超声测量第三、第四和第五肋间隙ITA直径和PSV。构建多变量线性回归模型，评估术前ITA超声参数与移植物术中流量的关系，采用流量计瞬时流量测量法测量移植物术中流量。结果ITA检查显示98.0%未见狭窄，1.0%出现轻度异常（斑块或轻度狭窄），0.8%出现曲折。同样，96.7%的锁骨下动脉无狭窄，中度狭窄占2.0%，严重狭窄或闭塞占1.3%。在椎动脉中，只有3.5%表现为严重狭窄或闭塞。在调整各种混杂因素后，第四肋间隙的PSV与术中ITA移植物流量显著相关（β = 0.399, 95% CI 0.109-0.689; P = 0.007）。此外，在调整年龄后，PSV≥65.0 cm/s似乎可以显著预测更好的ITA移植物流量（β = 10.527; P = 0.040），并观察到显著的线性趋势（P = 0.039）。结论术前ITA超声作为一种方便、经济、无创的方法，可用于术前ITA的评估，从而改善CABG的手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS Techniques Medicine-Surgery

CiteScore

1.60

自引率

6.20%

发文量

311