The Inferior Epigastric Artery: An Alternative Arterial Conduit for Coronary Artery Bypass Surgery

Fitxes dels barri

Intraoperative flow measurements in gastroepiploic grafts using pulsed Doppler 1

Abstract Objective: The patency of a pedicled right gastroepiploic artery (RGEA) graft can be compromised by intraoperative twists, kinks or spasms. Therefore, a systematic flow assessment was made in RGEA grafts and was compared with similar measurements made in other types of bypass conduits. Methods: Intraoperative pulsed Doppler flowmeter measurements obtained in a series of 556 consecutive patients undergoing at least one coronary bypass grafting onto the right coronary system were studied. Eighty-five RGEA grafts were compared with 1427 bypass grafts implanted in the same group of patients and consisted of the following conduits: 442 left internal mammary (LIMA), 149 right internal mammary (RIMA), 831 greater saphenous vein (GSV) and five inferior epigastric (EPIG) grafts. Sequential grafts were excluded from the analysis. Results: Flow measurements and Doppler waveforms were abnormal and required graft repositioning, and the addition of a distal graft or intragraft papaverine injection (only in GSVs) in 29 cases (2.0% of all grafts). These graft corrections were necessary in 5.9% RGEAs, 3.4% LIMAs, 2.0% RIMAs, and 0.7% GSVs (P Ͻ 0.001). The relative risk for graft correction was eight times higher for RGEAs than for GSVs (P = 0.002). Flow increased from 8 ± 2 to 54 ± 5 ml/min (P Ͻ 0.0001). Flow data were significantly influenced by the type of run-off bed (P Ͻ 0.001), the measurements obtained in grafts implanted onto the right coronary artery and the left anterior descending artery being superior. Flows in RGEAs, however, were comparable with values obtained in other grafts implanted onto the same recipient coronary artery. Conclusions: A significantly higher incidence of graft malpositioning caused inadequate flows in RGEAs. However, normal flow values could be restored simply by assigning a better graft orientation under pulsed Doppler flowmeter control. Overall flow capacity of the RGEA did not differ from values obtained in other arterial and venous grafts implanted onto the same recipient arteries

Results of the Ontology Alignment Evaluation Initiative 2022

The Ontology Alignment Evaluation Initiative (OAEI) aims at comparing ontology matching systems on precisely defined test cases. These test cases can be based on ontologies of different levels of complexity and use different evaluation modalities. The OAEI 2022 campaign offered 14 tracks and was attended by 18 participants. This paper is an overall presentation of that campaign

Current status of the inferior epigastric artery.

The current trend is to use more arterial conduits for myocardial revascularization. The rationale for this trend is that the late patency rate of internal thoracic artery grafts has been shown to be superior to that of saphenous vein grafts. The desire to achieve complete myocardial revascularizations only with arterial conduits has led to consideration of new arteries as coronary artery bypass grafts. Recently, the inferior epigastric artery has been proposed as one of these alternative grafts. It is expected that this new conduit will provide the same advantages as the free internal thoracic artery used in similar circumstances, but this assumption has not been validated yet. This article will review the clinical experience currently gained with the use of the inferior epigastric artery as a coronary artery bypass graft