Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation.
To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) angiography for prediction of availability of the right gastroepiploic artery (RGEA) for coronary artery bypass grafting surgery (CABG). This study included 149 patients who underwent both preoperative MDCT angiography and exploratory laparotomy to harvest the RGEA for CABG. The prediction of availability of RGEA using the MDCT finding was evaluated by comparing it to an exploratory laparotomy evaluation of RGEA as a gold standard. The MDCT findings of atherosclerosis and diameter of the RGEA were analyzed. The atherosclerosis of other visceral branches was also analyzed for the detection of affecting factors to the availability for CABG. Atherosclerotic change of vessel was defined as findings including vessel wall calcification, luminal irregularity, aneurysmal change, and apparent atheroma. For statistical analysis, unpaired t-test and receiver operating curve analyses were used to compare the size of the RGEA, and the chi-square test was used to evaluate significant determinant factors of RGEA availability. In exploratory laparotomy, 21 out of 149 RGEAs were classified as inappropriate as a graft for CABG. The reason for inappropriateness was atherosclerosis of RGEA in 15 patients and small diameter in six patients. Sensitivity, specificity, positive predictive value and negative predictive value of MDCT angiography for assessing RGEA atherosclerosis was 60, 99.6, 94.7 and 96.1%, respectively. Atherosclerotic change of the RGEA itself was the only significant determinant factor for predicting the appropriateness of each RGEA. The mean diameter was 1.94 mm in 21 inappropriate RGEAs and 2.41 mm in 128 appropriate RGEAs. This difference was significant (P = 0.001). The least diameter of appropriate RGEA was 1.4 mm on MDCT angiography, and the cut-off value determined by ROC analysis was 1.8 mm with 82.8% of sensitivity and 61.9% of specificity for inappropriate RGEA, and the area under the curve value was 0.729. MDCT is useful preoperative evaluation tool for RGEA availability. Findings of atherosclerosis of the RGEA and a small diameter on MDCT angiography suggest inappropriateness of the RGEA for CABG surgery.
Lee
Dong Ho
DH
Department of Radiology, Seoul National University Hospital, 28, Yeongon-dong, Jongno-gu, Seoul, 110-744, Korea.
Lee
Whal
W
Kim
Ki-Bong
KB
Cho
Kwang Ree
KR
Park
Eun-Ah
EA
Chung
Jin Wook
JW
Park
Jae Hyung
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging* / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020858:Tissue and Organ Harvesting; D014057:Tomography, X-Ray Computed