This case from the REQUEST study illustrates how High-Frequency Ultrasound Imaging (HFUS) can be used during surgery to detect intramural vessels, to avoid complications, and improve graft patency.
High-frequency ultrasound imaging of LAD embedded 6 mm deep
Intraoperative imaging during CABG
In this case the target site was an intramural LAD which would be difficult to find without the use of HFUS. By using the imaging probe the surgeon was able to detect the LAD at approximately 6 mm depth as shown in Image 1.This image also shows that the LAD has a lumen with a diameter ≥.5 mm in the scanned area. The vessel walls are nice and clean without plaque or calcifications confirming that this site is well suited for the planned anastomosis.
The intraoperative picture as seen in Image 2 shows the finished anastomosis and confirms that it is open. The graft was also assessed with TTFM and confirmed to have good flow and low PI.
Case attachments
Click images below to view.
Intramural LAD at 6 mm depth
Image of anastomosis confirming that it is open
Reference
Registry for Quality Assessment with Ultrasound Imaging and Transit-time Flow Measurement in Cardiac Bypass Surgery
Taggart DP et al. Intraoperative transit-time flow measurement and high-frequency ultrasound assessment in coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2019; 159:1283-1292.
DOI: https://doi.org/10.1016/j.jtcvs.2019.05.087
Technology used
Medistim MiraQ™ Cardiac System with QuickFit™ TTFM Probes and L15 High-Frequency Ultrasound Probe.
