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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(03): 332-337
DOI: 10.4103/ijri.IJRI_365_16
Intervention Radiology & Vascular

Use of multidetector computed tomography angiography of upper limb circulation in patients undergoing coronary artery bypass grafting surgery

Hasan B Altinsoy
Department of Radiology, Elazig Education and Research Hospital, Elazıg, Turkey
,
Ozkan Alatas
Department of Cardiovascular Surgery, Elazig Education and Research Hospital, Elazıg, Turkey
,
Hidayet Kayancicek
Department of Cardiology, Medicalpark University Elazığ Hospital, Elazıg, Turkey
,
Erhan Hafiz
Department of Cardiovascular Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey
,
Omer F Dogan
Adana Numune Education and Research Hospital, Adana, Cukurova, Turkey
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Objective: This study aimed to evaluate the bilateral forehand circulation using a 64-channel multidetector computed tomography (MDCT) as a noninvasive method to define criteria for an upper extremity arterial anatomy and pathology prior to the use of arterial conduits. Materials and Methods: Fifty-five patients with coronary artery disease who underwent total arterial coronary artery bypass grafting (CABG) were randomly selected for this prospective study. MDCT angiography was performed for 110 examinations of forearm and hand arterial anatomy. Prior to MDCT, Allen tests were performed in all patients with a normal result, except four. Thirteen patients had diabetes mellitus (DM), 8 had peripheral artery occlusive disease, and 19 had a history of smoking. Results: All arteries, including axillary, ulnar artery (UA) and radial artery (RA), were clearly visualized in all patients. Upper extremity anatomical and pathological results were examined in 16 patients (29.1%). Severely calcified RA and/or UA were found in 6 patients who had a moderate renal failure. Nearly total occlusion of the RA was detected in another two patients. Focal intimal RA calcification was recorded in 1 female and 3 male patients. Ten patients who had severe calcification or intimal sclerosis of the upper extremity arteries had DM. The remaining patients had normal forehand arterial circulation. A persistent median artery with the absence of radial and ulnar arteries and a high bifurcation of RA from the brachial artery was detected as an anatomic variation in seven patients (12.7%). Conclusions: The major advantages of MDCT angiography are its non-invasiveness and the ability to detect calcific subadventitial plaques, which are difficult to diagnose using conventional angiography. MDCT may be used as a safe and non-invasive method to assess RA and UA prior to harvesting the upper limb artery. Preoperative imaging of forehand arteries is a means to avoid unnecessary forearm exploration or the use of an unsuitable arterial conduit in CABG operations, especially in patients with DM and moderate renal impairment.

Keywords

Duplex ultrasonography - hand circulation - multislice computed tomography angiography


Publication History

Article published online:
27 July 2021

© 2017. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Kaufer E, Factor SM, Frame R, Brodman RF. Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts. Ann Thorac Surg 1997;63:1118-22.
  • 2 Acar C, Ramshey A, Pagny JY, Jebara V, Barrier P, Fabiani JN, et al. The radial artery for coronary bypass grafting. Clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998;116:981-9.
  • 3 Possati G, Gaudino M, Alessandrini M, Luciani N, Glieca F, Trani C, et al. Midterm clinical and angiographic results of radial artery grafts used myocardial revascularisation. J Thorac Cardiovasc Surg 1998;1116:1015-21.
  • 4 Pola P, Serrichio M, Flore R, Manasse E, Favuzzi A, Possati GF. Safe removal of the radial artery for myocardial revascularization: A Doppler study to prevent ischemic complications to the hand. J Thorac Cardiovasc Surg 1996;112:737-44.
  • 5 Nicolosi AC, Pohl LL, Parsons P, Cambria RA, Olinger GN. Increased incidence of radial artery calcification in patients with diabetes mellitus. J Surg Research 2002;102:1-5.
  • 6 Ruengsakulrach P, Brooks M, Sinclair R, Hare D, Gordon I, Buxton B. Prevalence and prediction of calcification and plaques in radial artery grafts by ultrasound. J Thorac Cardiovasc Surg 2001;122:398-9.
  • 7 Ofer A, Nitecki SS, Linn S, Epelman M, Fischer D, Karram T, et al. Multidetector CT angiography of peripheral vascular disease: A prospective comparison with intraarterial digital subtraction angiography. Am J Roentgenol 2003;180:719-24.
  • 8 Carpentier A, Guermonperez JL, Deloche A, Frechette C, DuBost C. The aorta-to-coronary artery bypass graft: A technique avoiding pathological changes in grafts. Ann Thorac Surg 1973;16:111-21.
  • 9 Martin ML, Tay KH, Flak B, Fry PD, Doyle DL, Taylor DC, et al. Multidetector CT angiography of the aortoiliac system and lower extremities: A prospective comparison with digital subtraction angiography. Am J Roentgenol 2003;180:1085-91.
  • 10 da Costa FDA, da Costa IA, Poffo R, et al. Myocardial revascularization with the radial artery: A clinical and angiographic study. Ann Thorac Surg 1996;62:475-80.
  • 11 Deshpande RP, Chukwuemeka A, Iqbal A, Desai JB. Calcification of the radial artery. Ann Thorac Surg 2000;69:1939-40.
  • 12 Nunoo-Mensah J. An unexpected complication after harvesting the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1998;66:929-31.
  • 13 Dogan OF, Karcaaltincaba M, Yorgancioglu C, Demircin M, Dogan R, Ersoy U, et al. Demonstration of coronary arteries and major cardiac vascular structures in congenital heart disease by cardiac multidetector computed tomography angiography. Heart Surg Forum 2007;10:90-4.
  • 14 Dogan OF, Guvener M, Demircin M, Karcaaltincaba M, Duman U. Diagnosis of a coronary artery anomaly by 16-channel computed tomography coronary angiography in an infant. Pediatr Cardiol 2006;27:658-9.
  • 15 Dick F, Hristic A, Roost-Krähenbühl E, Aymard T, Weber A, Tevaearai HT, et al. Persistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: A neglected side effect of coronary artery bypass grafting procedures. Eur J Cardiothorac Surg 2011;40:221-6.
  • 16 Pillai A. Popliteal artery entrapment syndrome: Diagnosis by MRI. Indian J Radiol Imag 2002;1:91-3.
  • 17 Kaplanoglu H, Beton O. Evaluation of anatomy and variations of superficial palmar arch and upper extremity arteries with CT angiography. Surg Radiol Anat 2016 [Epub ahead of print].
  • 18 Ki SH, Choi JH. Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography. J Korean Med Sci 2015;30:1302-7.
  • 19 Dogan OF, Karcaaltincaba M, Duman U, Akata D, Besim A, Boke E. Assessment of the radial artery and hand circulation by computed tomography angiography: a pilot study. Heart Surg Forum 2005;8:28-33.