2023 年 29 巻 3 号 p. 62-66
Objective: Placing the internal thoracic artery (ITA) graft ipsilateral to the arteriovenous fistula (AVF) for left anterior descending artery (LAD) revascularization in coronary artery bypass grafting (CABG) in hemodialysis patients may cause coronary steal. However, whether or not ipsilateral or contralateral ITA grafts affect the flow volume and pulsatility index measured based on the transit time flow measurement of the ITA-LAD anastomosis is unclear.
Materials and methods: Between January 2013 and December 2021, 52 hemodialysis patients who underwent CABG with ITA-LAD anastomosis were divided into two groups based on whether the ITA graft was implemented ipsilateral (n = 42) or contralateral (n = 10) to the AVF.
Results: The average age at surgery and the duration of hemodialysis were 65.4 ± 8.4 years old and 82.5 ± 54.5 months in the ipsilateral group and 66.9 ± 9.0 years old and 68.8 ± 52.6 months in the contralateral group. There were no significant differences between the ipsilateral and contralateral groups in terms of LAD stenosis (87.4% ± 12.3% vs. 86.8% ± 15.2%), left ventricular ejection fraction (49.0% ± 15.0% vs. 46.7% ± 14.4%), operation time (376.7 ± 83.2 vs. 407.6 ± 117.5 min), intraoperative flow (40.3 ± 24.0 vs 38.5 ± 16.5 mL/min), and pulsatility index (2.7 ± 1.2 vs. 2.3 ± 0.6) for ITA-LAD. There was no graft occlusion on computed tomography in either group at two weeks postoperatively.
Conclusions: Our study suggests that an ITA graft ipsilateral to the arteriovenous fistula may not always be contraindicated in hemodialysis patients and may be appropriate in most cases.
