Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

Abstract

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.

Brain MRA 3D Skeleton Extraction Based on Normal Plane Centroid Algorithm

“…Vascular skeleton extraction is a necessary step in the quantitative analysis of MRA image data. Because most of the existing skeleton extraction algorithms are twodimensional (also known as binary image thinning), 3D image skeleton extraction algorithms are relatively few and are mainly classified as corrosion algorithms, including the iterative thinning method used by MASSEY et al [6]. The minimum path method proposed by JIN et al [7] and other machine learning methods emerged with the development of artificial intelligence technologyhowever, the precision of corrosion algorithm refinement in this method is needed.…”

“…The most commonly used 3D skeleton extraction algorithm is the corrosion algorithm [6,33,34], which corrodes the outermost outline from the outer layer and iterates continuously until the innermost Skeleton of the image remains. The centroid algorithm [7,[35][36][37] is also used in the skeleton extraction of two-dimensional images.…”

Adventitial dissection: a simple and effective way to reduce radial artery spasm in coronary bypass surgery

“…The true postoperative patency of the adventitial dissected RA can be determined by angiographic follow-up. Adventitial dissection results in a visible increase in vessel diameter, so it is hypothesized that the increase in free blood flow is due to an increase in lumen diameter, comparable with the skeletonization technique as shown for the IMA [11,[20][21][22][23].…”

“…Perioperative use of vasodilating drugs may be insufficient to entirely prevent early postoperative spasm of the RA [4,5,10]. On the other hand, the method of RA harvesting and handling may play an even more important role in preventing spasm [5,11].…”