Advertisement

Ultrasound Evaluation of Subclavian Artery and Internal Thoracic Artery Before Coronary Artery Bypass Grafting as Part of Preoperative Vascular Assessment

      Rationale and Objectives

      Noninvasive diagnostic imaging of subclavian artery (SCA) and internal thoracic artery (ITA) is crucial to the patients planning to use ITA for coronary artery bypass grafting (CABG). The guidelines have not yet provided guidance on screening high-risk groups. The present study aimed to evaluate the contribution of ultrasonography in the assessment of SCA and ITA, especially for the patients referred for CABG who planned to use ITA graft.

      Materials and Methods

      Patients diagnosed with multivessel coronary heart disease were enrolled and some of them planned CABG. Bilateral SCAs and ITAs were routinely evaluated by color Doppler ultrasound (CDUS) before operation. The luminal diameter and the peak systolic velocity of the proximal and distal parts of SCA and ITA were measured. Depending on the Doppler waveform, the lumen narrowing rate was calculated.

      Results

      The final analysis was carried out in 572 patients. Thirty-five patients had moderate (50%-69%), severe (70%-99%) stenosis or occlusion in the SCA (left-sided in 21 and right-sided in 14). One patient had severe proximal stenosis in left ITA and one patient had no flow in left ITA due to the occlusion in left SCA. One patient had anatomic variation of isolated right aortic arch with aberrant left SCA. All of those cases were confirmed with multidetector computed tomography angiography.

      Conclusion

      CDUS could be used for the evaluation of SCA and ITA before CABG as part of presurgical vascular assessment and provide an import basis for the imaging diagnosis and surgical plan.

      Key words

      Abbreviations:

      SCA (subclavian artery), ITA (internal thoracic artery), CABG (coronary artery bypass grafting), CDUS (color Doppler ultrasound), LITA (left internal thoracic artery), SAS (subclavian artery stenosis), CSSS (coronary subclavian steal syndrome), PSV (peak systolic velocity), D1 (residual diameter), D2 (original diameter), ICC (intra-class correlation coefficient), SSS (subclavian-vertebral artery steal syndrome), CTA (computed tomography angiography), RAA (right aortic arch), SVG (saphenous vein graft)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mohr FW
        • Morice M-C
        • Kappetein AP
        • et al.
        Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
        The Lancet. 2013; 381: 629-638https://doi.org/10.1016/s0140-6736(13)60141-5
        • Neumann F-J
        • Sousa-Uva M
        • Anders Ahlsson FA
        • et al.
        2018 ESC/EACTS Guidelines onmyocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2019; 40: 87-165https://doi.org/10.1093/eurheartj/ehy394
        • Jayakumar S
        • Gasparini M
        • Treasure T
        • Burdett C.
        How do surgeons decide? Conduit choice in coronary artery bypass graft surgery in the UKdagger.
        Interact Cardiovasc Thorac Surg. 2019; 29: 179-186https://doi.org/10.1093/icvts/ivz047
        • Sajja LR
        • Mannam G.
        Internal thoracic artery: anatomical and biological characteristics revisited.
        Asian Cardiovasc Thorac Ann. 2015; 23: 88-99https://doi.org/10.1177/0218492314523629
        • Kurlansky PA
        • Traad EA
        • Dorman MJ
        • et al.
        Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups.
        Ann Thorac Surg. 2010; 90: 101-108https://doi.org/10.1016/j.athoracsur.2010.04.006
        • Galbut DL
        • Kurlansky PA
        • Traad EA
        • et al.
        Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction: a propensity-matched study with 30-year follow-up.
        J Thorac Cardiovasc Surg. 2012; 143 (e844): 844-853https://doi.org/10.1016/j.jtcvs.2011.12.026
        • Ochoa VM
        • Yeghiazarians Y.
        Subclavian artery stenosis: a review for the vascular medicine practitioner.
        Vasc Med. 2011; 16: 29-34https://doi.org/10.1177/1358863×10384174
        • Waduud MA
        • Giannoudi M
        • Drozd M
        • et al.
        Coronary subclavian steal syndrome-is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?.
        Oxf Med Case Reports. 2018; 2018: omy102https://doi.org/10.1093/omcr/omy102
        • Elami A
        • Zlotnick AY.
        Diffuse atherosclerosis of the left internal mammary artery.
        J Card Surg. 2015; 30: 819https://doi.org/10.1111/jocs.12613
        • Heidt ST
        • Ganesh SK
        • Liu P
        • Froehlich JB
        • Kline-Rogers E.
        Bilateral internal mammary artery fibromuscular dysplasia discovered upon evaluation for reconstructive breast surgery.
        Vasc Med. 2015; 20: 487-488https://doi.org/10.1177/1358863×15576066
        • Potter BJ
        • Pinto DS.
        Subclavian steal syndrome.
        Circulation. 2014; 129: 2320-2323https://doi.org/10.1161/CIRCULATIONAHA.113.006653
        • Usmanij EA
        • Senden PJ
        • Meiss L
        • JMHd K.
        Myocardial ischaemia due to subclavian stenosis after coronary artery bypass graft: a case report.
        Eur Heart J Case Rep. 2018; 2: 1-6https://doi.org/10.1093/ehjcr/yty069
        • Brott TG
        • Halperin JL
        • Abbara S
        • et al.
        2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography.
        Catheter Cardiovasc Interv. 2013; 81: E76-123https://doi.org/10.1002/ccd.22983
        • Gao J
        • Zhao Z
        • Zhu J
        • Tian H
        • Liu Y.
        The role of color Doppler ultrasonography in the perioperative period of coronary artery bypass grafting: comparison with transit-Time flow measurement.
        Cardiology. 2021; 146: 583-590https://doi.org/10.1159/000512430
        • Yurdakul M
        • Tola M
        • Uslu OS.
        Color Doppler ultrasonography in occlusive diseases of the brachiocephalic and proximal subclavian arteries.
        J Ultrasound Med. 2008; 27: 1065-1070https://doi.org/10.7863/jum.2008.27.7.1065
        • Hua Y
        • Jia L
        • Li L
        • et al.
        Evaluation of severe subclavian artery stenosis by color Doppler flow imaging.
        Ultrasound Med Biol. 2011; 37: 358-363https://doi.org/10.1016/j.ultrasmedbio.2010.12.003
        • Kargiotis O
        • Siahos S
        • Safouris A
        • et al.
        Subclavian steal syndrome with or without Arterial Stenosis: a review.
        J Neuroimaging. 2016; 26: 473-480https://doi.org/10.1111/jon.12371
        • Hathout GM
        • Fink JR
        • El-Saden SM
        • Grant EG.
        Sonographic NASCET index: a new doppler parameter for assessment of internal carotid artery stenosis.
        AJNR Am J Neuroradiol. 2005; 26 (Available at): 68-75
        • Waduud MA
        • Giannoudi M
        • Drozd M
        • et al.
        Coronary subclavian steal syndrome-is there a need for routine assessment for subclavian artery stenosis following coronary bypass surgery?.
        Oxf Med Case Reports. 2018; 12: 434-437https://doi.org/10.1093/omcr/omy102
        • Abdul Jabbar A
        • Houston J
        • Burket M
        • et al.
        Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it?.
        Echocardiography. 2017; 34: 928-933https://doi.org/10.1111/echo.13528
        • Rogers JH
        • Calhoun RF.
        Diagnosis and management of subclavian artery stenosis prior to coronary artery bypass grafting in the current era.
        J Card Surg. 2007; 22: 20-25https://doi.org/10.1111/j.1540
        • Aboyans V
        • Kamineni A
        • Allison MA
        • et al.
        The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Atherosclerosis. 2010; 211: 266-270https://doi.org/10.1016/j.atherosclerosis.2010.01.013
        • Cardon A
        • Leclercq C
        • Brenugat S
        • Jego P
        • Kerdiles Y.
        Coronary subclavian steal syndrome after left internal mammary bypass in a patient with Takayasu's disease.
        J Cardiovasc Surg (Torino). 2002; 43 (Available at:): 471-473
        • Bauer P
        • Most AK
        • Hamm CW
        • Gunduz D.
        Coronary steal syndrome after left internal mammary bypass in a patient with undiagnosed Takayasu arteritis.
        Clin Res Cardiol. 2017; 106: 388-391https://doi.org/10.1007/s00392-017-1083-4
        • Osborn LA
        • Vernon SM
        • Reynolds B
        • Timm TC
        • Allen K.
        Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery.
        Catheter Cardiovasc Interv. 2002; 56: 162-165https://doi.org/10.1002/ccd.10198
        • Spadaccio C
        • Fremes SE
        • Gaudino MFL.
        Right internal thoracic or radial artery as the second arterial conduit for coronary artery bypass surgery.
        Curr Opin Cardiol. 2019; 34: 564-570https://doi.org/10.1097/HCO.0000000000000654
        • Lehmann KH
        • von Segesser L
        • Muller-Glauser W
        • et al.
        Internal-mammary coronary artery grafts: is their superiority also due to a basically intact endothelium?.
        Thorac Cardiovasc Surg. 1989; 37: 187-189https://doi.org/10.1055/s-2007-1020315
        • Otsuka F
        • Yahagi K
        • Sakakura K
        • Virmani R.
        Why is the mammary artery so special and what protects it from atherosclerosis?.
        Ann Cardiothorac Surg. 2013; 2: 519-526https://doi.org/10.3978/j.issn.2225-319X.2013.07.06
        • Karaman B
        • Battal B
        • Bozkurt Y
        • et al.
        The anatomic evaluation of the internal mammary artery using multidetector CT angiography.
        Diagn Interv Radiol. 2012; 18: 215-220https://doi.org/10.4261/1305-3825.DIR.4788-11.1
        • Gao J
        • Zhu J
        • Pei Q
        • Li J.
        Prenatal ultrasonic diagnosis and differential diagnosis of isolated right aortic arch with mirror-image branching.
        Arch Gynecol Obstet. 2017; 295: 1291-1295https://doi.org/10.1007/s00404-017-4310-3
        • Seo HK
        • Je HG
        • Kang IS
        • Lim KA.
        Prenatal double aortic arch presenting with a right aortic arch and an anomalous artery arising from theascending aorta.
        Int J Cardiovasc Imaging. 2010; 26 Suppl 1: 165-168https://doi.org/10.1007/s10554-009-9553-z
        • Bonnard A
        • Auber F
        • Fourcade L
        • et al.
        Vascular ring abnormalities: a retrospective study of 62 cases.
        J Pediatr Surg. 2003; 38: 539-543https://doi.org/10.1053/jpsu.2003.50117
        • Galindo A
        • Nieto O
        • Nieto MT
        • et al.
        Prenatal diagnosis of right aortic arch: associated findings, pregnancy outcome, and clinical significance of vascular rings.
        Prenat Diagn. 2009; 29: 975-981https://doi.org/10.1002/pd.2327
        • Higashikuni Y
        • Nagashima T
        • Ishizaka N
        • et al.
        Right aortic arch with mirror image branching and vascular ring.
        Int J Cardiol. 2008; 130: e53-e55https://doi.org/10.1016/j.ijcard.2007.06.150
        • Kablak-Ziembicka A
        • Przewlocki T
        • Pieniazek P
        • et al.
        Doppler ultrasonography in suspected subclavian artery obstruction and in patient monitoring after subclavian stenting.
        Cardiovasc Intervent Radiol. 2007; 30: 894-900https://doi.org/10.1007/s00270-007-9011-z