Abstract：Objective To explore the clinical application value of Doppler ultrasound in the evaluation of the radial artery and left internal mammary artery before coronary artery bypass grafting(CABG).Methods Retrospective research. This study enrolled 60 patients with coronary heart disease, including 34 males and 26 females, aged 44-76 years old, admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2020. All patients used Doppler ultrasound to examine the left internal mammary artery and bilateral radial artery before operation. (1)The types of collateral circulation on both palms of 60 patients were detected by ultrasound examination and Allen's test, and patients with radial artery-dependent blood vessels or abnormal blood vessels were initially screened out. In patients undergoing total arterial bypass, the intraoperative results of Allen's test and ultrasound examination to determine the type of palmar collateral circulation were compared. (2)The inner diameters 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 were measured and compared. (3)The peak systolic velocity (PSV) changes and growth of the ulnar artery of different collateral circulation types were observed under the pressing and relaxing states of the radial artery. (4)The inner diameter and PSV of the left internal mammary artery at the second intercostal level were recorded, the blood flow direction at the beginning was observed, and whether or not stenosis exists and whether or not the lower end of the internal mammary artery bifurcates in the fourth intercostal were determined. (5)The relationship between the blood flow of the radial artery graft and the internal diameter of the preoperative radial artery was analyzed in patients with total artery bypass graft. (6)The improvement of chest tightness, angina pectoris, and acute cardiovascular events, such as myocardial infarction, was observed 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) Sixty patients were initially screened and 44 underwent total artery bypass surgery. Then, 78 radial arteries were dissected during the operation. The intraoperative tests were all non-radial artery dependent. Allen's test detected 10 radial artery-dependent and 68 non-radial artery-dependent blood vessels, whereas the Doppler ultrasound detected 3 radial artery-dependent blood vessels and 75 non-radial artery-dependent blood vessels. The accuracy rate of non-radial artery-dependent blood vessels determined by ultrasound measurement was 96.2%, which was significantly higher than the 87.2% of Allen's test (χ2=4.000, P＜0.05). (2) The inner diameters of the blood vessels at the radial styloid process, the middle section, and the lower section of the elbow joint of the radial artery were (2.06±0.44), (2.38±0.43), and (2.37±0.43) mm, respectively, and the difference was statistically significant (n=120, F=21.542, P＜0.05). (3) The preoperative ultrasound examination showed that 17 cases of palmar collateral circulation was radial artery-dependent. The PSV of the ulnar artery before and after the radial artery was not changed significantly, and the difference was not statistically significant (P＞0.05). The operation confirmed 78 non-radial artery dependent 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 left internal mammary artery of the 60 patients did not show any abnormalities, such as initial stenosis, variation, and reverse blood flow. Among them, the left internal mammary artery of seven patients branched into phrenic artery at the fourth intercostal level and the upper abdominal artery. In the 60 patients, the internal diameter of the left internal mammary 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 one patient had a blood vessel diameter of 1.5 mm and a PSV of 12.2 cm/s. In 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, all in the normal range. (5) Simple linear regression analysis showed that the blood flow of the intraoperative radial artery bridge positively correlated with the diameter of the radial artery measured before the operation(＾Y=18.503X-4.471, R2=0.499). (6) The operation was successfully performed for all 40 patients. The clinical symptoms improved during hospitalization, and no perioperative myocardial infarction occurred. After discharge, all 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 the coronary artery CTA at 3 months after surgery showed that the grafts were unobstructed and no obvious abnormalities. Ultrasonography showed normal blood supply to the radial palm.Conclusions Doppler ultrasound can measure the inner diameter of the graft vessel and determine whether or not the graft vessel has stenosis or other abnormalities. It can accurately and efficiently evaluate the radial artery and internal mammary artery before CABG; at the same time, Doppler ultrasound can determine whether or not it is radial. The accuracy rate of arterial-dependent blood vessels is higher in Doppler ultrasound than in Allen's test, indicating its higher clinical application value.
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2021, Vol. 26 
