| Objective : To explore the clinical application value of Doppler ultrasound in evaluating the radial artery and left internal mammary artery before fully arterialized coronary artery bypass graft surgery.Methods:Sixty patients with coronary heart disease admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2020 were included,including 34 males and 26 females,aged 44-76 years old.All patients used Doppler ultrasound to examine the left internal thoracic artery and bilateral radial artery before operation.(1)Ultrasonic examination and Allen test were used to detect the types of palmar collateral circulation in 60 patients.The two methods were initially screened out for patients with radial artery-dependent blood vessels or abnormal blood vessels.In patients undergoing total arterial bypass,based on the intraoperative test results,the Allen test and ultrasound test were compared to determine the difference in the types of palmar collateral circulation.(2)Measure and compare the inner diameter of the blood vessels at the radial styloid process of the radial artery,5 cm below the elbow joint(lower section of the elbow joint)and the midpoint(middle section)of the two.(3)Observe the change and growth of the peak blood velocity(PSV)of the ulnar artery of different collateral circulation types under the state of pressing and relaxing the radial artery.(4)Record the inner diameter and PSV of the second intercostal level of the left internal thoracic artery,observe the blood flow direction at the beginning,whether there is stenosis,and whether the lower end of the internal mammary artery is bifurcated in the fourth intercostal.(5)Analyze the relationship between the blood flow of the radial artery graft and the internal diameter of the preoperative radial artery in patients with total artery bypass graft.(6)Observe the improvement of chest tightness,angina pectoris,and acute cardiovascular events such as myocardial infarction in patients with total artery bypass grafting.Three months after surgery,coronary CTA and hand ultrasound were performed to observe the patency of the graft vessels and the blood supply of the radial palm.Results:(1)After initial screening,60 patients were enrolled in 44 patients for total artery bypass surgery.78 radial arteries were dissected during the operation.The intraoperative tests were all non-radial artery-dependent,and Allen test detected 10 radial artery-dependent.,68 non-radial artery dependent blood vessels,3 radial artery dependent blood vessels detected by Doppler ultrasound,75 non-radial artery dependent blood vessels detected by Doppler ultrasound,the accuracy rate of non-radial artery dependent blood vessels determined by ultrasound measurement is96.2%,which is higher than the 87.2 of Allen test %,the difference was statistically significant(χ2=4.00,P<0.05).(2)The inner diameters of the blood vessels at the radius styloid process,the middle section and the lower section of the elbow joint of the 120 radial arteries were(2.06±0.44),(2.38±0.43),(2.37±0.43)mm,and the difference was statistically significant(F=21.542,P<0.05).(3)Preoperative ultrasound detected 17 radial artery-dependent blood vessels in the palmar collateral circulation.The PSV of the ulnar artery before and after the radial artery was compressed did not change significantly,and the difference was not statistically significant(P>0.05).Surgery proved 78 non-radial artery-dependent blood vessels.The PSV of the ulnar artery after compression of the radial artery was(69.8±13.6)cm/s,which was significantly higher than the(42.0±7.4)cm/s before compression.The difference was statistically significant(t =23.346,P<0.05).(4)The detection of the left internal thoracic artery in 60 patients showed no abnormalities such as initial stenosis,variation,and reverse blood flow.Among them,the left internal thoracic artery branched into the diaphragm at the fourth intercostal level in 7 patients Arteries and superior abdominal wall arteries.In 60 patients,the internal diameter of the left internal thoracic artery in the second intercostal space was(2.29±0.38)mm,and the PSV was(67.8±15.9)cm/s.Among them,only 1 patient had a blood vessel diameter of 1.5 mm and a PSV of 12.2 cm/s.Other patients The inner diameter of the blood vessel was more than 1.5 mm,and the PSV was more than 40.0 cm/s,which were all within the normal range.(5)Multiple linear regression analysis showed that there were 77 radial artery grafts,and the blood flow of the radial artery grafts during the operation was positively correlated with the diameter of the radial artery measured before the operation and the mean arterial pressure during the operation.(6)All 44 patients successfully completed the total artery bypass surgery.The clinical symptoms improved during hospitalization,and no perioperative myocardial infarction occurred.After discharge,44 patients were followed up for 3 months.During the follow-up period,the patients had no chest tightness,angina pectoris,or hand ischemic dysfunction and other complications.Re-examination of coronary artery CTA at 3months after operation showed that the grafts were unobstructed and there were no obvious abnormalities;An ultrasound examination showed that the blood supply of the radial palm was normal.Conclusion : Doppler ultrasound can measure the internal diameter of the graft vessel and judge whether the graft vessel has stenosis or other abnormal conditions.It can accurately and efficiently complete the evaluation of the radial artery and internal thoracic artery before CABG;at the same time,Doppler ultrasound can determine the non-radial The accuracy of arterial-dependent blood vessels is higher than that of Allen’s test,which has higher clinical application value. |
