Ignite Creation Date:
2024-05-06 @ 11:41 AM
Last Modification Date:
2024-10-26 @ 12:48 PM
Study NCT ID:
NCT03577821
Status:
UNKNOWN
Last Update Posted:
2018-07-05
First Post:
2018-06-08
Brief Title:
Early Outcome of Total Arterial Revasclarization in IHD
Sponsor:
Assiut University
Organization:
Assiut University
Study Overview
Official Title:
Surgical Modalities and Early Outcome of Total Arterial Revascularization in CABG
Status:
UNKNOWN
Status Verified Date:
2018-06
Last Known Status:
NOT_YET_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Complete arterial coronary artery bypass grafting CABG is a surgical option to improve long-term results in the treatment of coronary artery disease CAD The goal of coronary artery bypass operations is complete revascularization and there is an increasing interest toward complete arterial revascularization to achieve this goal because of high late failure of saphenous vein graft
Detailed Description:
The availability of arterial conduit which is long enough to perform complete arterial revascularization is the limitation of the procedure and it is mandatory to adjust length of the available graft to serve the need To overcome this problem sequential or and composite grafting techniques are used and one conduit is used for more than one distal anastomoses or multiple arterial grafts are preferred Bilateral internal mammarian arteries IMAs the gastroepiploic artery GEA inferior epigastric artery and the radial artery RA have been used as conduits in selected patients However sequential grafting using arterial grafts may not be convenient for all circumstances and sometimes surgical technique may be challenging Besides classical Y-graft technique of RA has the disadvantage of shortening the graft Harvesting multiple arterial conduits is more time consuming and may result in elevated operative trauma and perioperative complications sternal dehiscence sternal infection pulmonary complications required laparatomy prolonged ICU time and hospitalization time etc Every eligible patient should receive total arterial revascularization the cornerstone of which is BITA grafting Patients with a body mass index BMI of over 35 diabetes or severe airway disease or who are undergoing radio- therapy or immunosuppression are only relatively contra- indicated for BITA use7 If more conduits are required the RA can be prepared at the same time as the LITA and its harvesting is associated with favorable early outcomes Prior to harvesting a modified Allen test is performed If a hyperemic response to the previous ischemic hand is noticed within 5 s the collateral ulnar circulation is adequate Restoration of the blood circulation to the ischemic hand later than 10 s after the ulnar release excludes the RA from being used
Duplex examination and pulse oximetry can also be used to preoperatively evaluate the RA and ulnar artery Moreover the RA should be avoided when cardiac catheterization has been recently pre- ceded by injuring the vessel and when the RA might be used for future fistulae in patients who are receiving or who are likely to receive dialysis RAs less than 2 mm in diameter are also avoided due to the possibility of vasospasm
Finally the extent of stenosis of the target coronary vessel may also constitute a contraindication for arterial conduit use due to competitive flow Hence stenoses of less than 70 in the left coronary bed and less than 90 in a dominant right coronary artery should prevent the use of an arterial graft
Duplex examination and pulse oximetry can also be used to preoperatively evaluate the RA and ulnar artery Moreover the RA should be avoided when cardiac catheterization has been recently pre- ceded by injuring the vessel and when the RA might be used for future fistulae in patients who are receiving or who are likely to receive dialysis RAs less than 2 mm in diameter are also avoided due to the possibility of vasospasm
Finally the extent of stenosis of the target coronary vessel may also constitute a contraindication for arterial conduit use due to competitive flow Hence stenoses of less than 70 in the left coronary bed and less than 90 in a dominant right coronary artery should prevent the use of an arterial graft
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None