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==Overview==
==Overview==
 
Since [[atherosclerotic disease]] of the [[aorta]] is a common finding in [[patients]] who undergo [[CABG]] [[surgery]], usage of [[ultrasonography|epiaortic ultrasonography]] is recommended for identifying [[aorta|aortic]] [[atherosclerosis]]. This imaging has been recognized as the [[Gold standard (test)|gold standard]] for identifying [[aorta|aortic]] [[atherosclerosis]] due to its superiority to either [[surgery|surgical]] digital [[palpation]] or [[transesophageal echocardiography]].
==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
 
*The [[prevalence]] of [[atherosclerotic disease]] of the [[aorta]] ranges from 19% to 90% among [[patients]] who undergo [[CABG]] [[surgery]], based on the [[patient]] population and the [[examination]] modality.<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446  }} </ref><ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963  }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056  }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309  }} </ref><ref name="pmid12928635">{{cite journal| author=Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G | display-authors=etal| title=Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 126 | issue= 2 | pages= 391-400 | pmid=12928635 | doi=10.1016/s0022-5223(03)00395-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12928635  }} </ref>
*A clear association has been reported between [[aorta|aortic]] [[atherosclerosis]] and [[stroke]], particularly among [[patients]] who are undergoing [[CABG]].<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446  }} </ref><ref name="pmid10441102">{{cite journal| author=Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG| title=Risk factors for early or delayed stroke after cardiac surgery. | journal=Circulation | year= 1999 | volume= 100 | issue= 6 | pages= 642-7 | pmid=10441102 | doi=10.1161/01.cir.100.6.642 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441102  }} </ref><ref name="pmid8948560">{{cite journal| author=Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R | display-authors=etal| title=Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 25 | pages= 1857-63 | pmid=8948560 | doi=10.1056/NEJM199612193352501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948560  }} </ref><ref name="pmid15284448">{{cite journal| author=Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D | display-authors=etal| title=Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. | journal=Stroke | year= 2004 | volume= 35 | issue= 9 | pages= e356-8 | pmid=15284448 | doi=10.1161/01.STR.0000138783.63858.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284448  }} </ref><ref name="pmid16126401">{{cite journal| author=Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J| title=The influence of ascending aortic atherosclerosis on the long-term survival after CABG. | journal=Eur J Cardiothorac Surg | year= 2005 | volume= 28 | issue= 4 | pages= 558-62 | pmid=16126401 | doi=10.1016/j.ejcts.2005.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16126401  }} </ref>
*[[ultrasonography|Epiaortic ultrasonography]] is recognized as the [[Gold standard (test)|gold standard]] for identifying [[aorta|aortic]] [[atherosclerosis]] due to its superiority to either [[surgery|surgical]] digital [[palpation]] or [[transesophageal echocardiography]].<ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963  }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056  }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309  }} </ref><ref name="pmid8837572">{{cite journal| author=Dávila-Román VG, Phillips KJ, Daily BB, Dávila RM, Kouchoukos NT, Barzilai B| title=Intraoperative transesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta. | journal=J Am Coll Cardiol | year= 1996 | volume= 28 | issue= 4 | pages= 942-7 | pmid=8837572 | doi=10.1016/s0735-1097(96)00263-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8837572  }} </ref><ref name="pmid9914464">{{cite journal| author=Royse C, Royse A, Blake D, Grigg L| title=Screening the thoracic aorta for atheroma: a comparison of manual palpation, transesophageal and epiaortic ultrasonography. | journal=Ann Thorac Cardiovasc Surg | year= 1998 | volume= 4 | issue= 6 | pages= 347-50 | pmid=9914464 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9914464  }} </ref><ref name="pmid18823455">{{cite journal| author=Van Zaane B, Zuithoff NP, Reitsma JB, Bax L, Nierich AP, Moons KG| title=Meta-analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery. | journal=Acta Anaesthesiol Scand | year= 2008 | volume= 52 | issue= 9 | pages= 1179-87 | pmid=18823455 | doi=10.1111/j.1399-6576.2008.01694.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18823455  }} </ref>
===2021 ACA Revascularization Guideline===
===2021 ACA Revascularization Guideline===
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==References==
 
{{Reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Since atherosclerotic disease of the aorta is a common finding in patients who undergo CABG surgery, usage of epiaortic ultrasonography is recommended for identifying aortic atherosclerosis. This imaging has been recognized as the gold standard for identifying aortic atherosclerosis due to its superiority to either surgical digital palpation or transesophageal echocardiography.

Use of Epiaortic Ultrasound in Patients Undergoing CABG

2021 ACA Revascularization Guideline

Class 2a Recommendation, Level of Evidence: B-NR[13][14][15][16][17][18][19][20][21][22][23]
The routine use of epiaortic ultrasound scanning is found to be helpful in identifying the presence, location, and severity of plaque in the ascending aorta to minimize the incidence of atheroembolic complications among patients who are undergoing CABG.

References

  1. ↑ 1.0 1.1 Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT (1994). "Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients". Stroke. 25 (10): 2010–6. doi:10.1161/01.str.25.10.2010. PMID 8091446.
  2. ↑ 2.0 2.1 Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N; et al. (2005). "Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma". Chest. 127 (1): 60–5. doi:10.1378/chest.127.1.60. PMID 15653963.
  3. ↑ 3.0 3.1 Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M; et al. (2007). "An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography". J Cardiothorac Vasc Anesth. 21 (6): 805–9. doi:10.1053/j.jvca.2007.05.014. PMID 18068056.
  4. ↑ 4.0 4.1 Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF; et al. (1997). "The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation". J Cardiothorac Vasc Anesth. 11 (6): 704–7. doi:10.1016/s1053-0770(97)90161-0. PMID 9327309.
  5. ↑ Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G; et al. (2003). "Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting". J Thorac Cardiovasc Surg. 126 (2): 391–400. doi:10.1016/s0022-5223(03)00395-7. PMID 12928635.
  6. ↑ Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG (1999). "Risk factors for early or delayed stroke after cardiac surgery". Circulation. 100 (6): 642–7. doi:10.1161/01.cir.100.6.642. PMID 10441102.
  7. ↑ Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R; et al. (1996). "Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators". N Engl J Med. 335 (25): 1857–63. doi:10.1056/NEJM199612193352501. PMID 8948560.
  8. ↑ Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D; et al. (2004). "Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery". Stroke. 35 (9): e356–8. doi:10.1161/01.STR.0000138783.63858.62. PMID 15284448.
  9. ↑ Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J (2005). "The influence of ascending aortic atherosclerosis on the long-term survival after CABG". Eur J Cardiothorac Surg. 28 (4): 558–62. doi:10.1016/j.ejcts.2005.07.004. PMID 16126401.
  10. ↑ Dávila-Román VG, Phillips KJ, Daily BB, Dávila RM, Kouchoukos NT, Barzilai B (1996). "Intraoperative transesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta". J Am Coll Cardiol. 28 (4): 942–7. doi:10.1016/s0735-1097(96)00263-x. PMID 8837572.
  11. ↑ Royse C, Royse A, Blake D, Grigg L (1998). "Screening the thoracic aorta for atheroma: a comparison of manual palpation, transesophageal and epiaortic ultrasonography". Ann Thorac Cardiovasc Surg. 4 (6): 347–50. PMID 9914464.
  12. ↑ Van Zaane B, Zuithoff NP, Reitsma JB, Bax L, Nierich AP, Moons KG (2008). "Meta-analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery". Acta Anaesthesiol Scand. 52 (9): 1179–87. doi:10.1111/j.1399-6576.2008.01694.x. PMID 18823455.
  13. ↑ Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  14. ↑ Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A; et al. (2020). "Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting". Ann Thorac Surg. 109 (1): 294–301. doi:10.1016/j.athoracsur.2019.06.078. PMID 31421104.
  15. ↑ Yamaguchi A, Adachi H, Tanaka M, Ino T (2009). "Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery". Ann Thorac Cardiovasc Surg. 15 (2): 98–104. PMID 19471223.
  16. ↑ Das S, Dunning J (2004). "Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery?". Interact Cardiovasc Thorac Surg. 3 (1): 71–5. doi:10.1016/S1569-9293(03)00220-2. PMID 17670180.
  17. ↑ Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C; et al. (2008). "Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery". Anesth Analg. 106 (6): 1611–8. doi:10.1213/ane.0b013e318172b044. PMID 18499587.
  18. ↑ Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J (2004). "Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients". Ann Thorac Surg. 78 (5): 1579–85. doi:10.1016/j.athoracsur.2004.05.051. PMID 15511435.
  19. ↑ Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ (2013). "Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass". Br J Anaesth. 111 (3): 374–81. doi:10.1093/bja/aet113. PMID 23611913.
  20. ↑ Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA; et al. (2009). "Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting". Innovations (Phila). 4 (2): 99–105. doi:10.1097/IMI.0b013e3181a3476f. PMID 22436990.
  21. ↑ Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S; et al. (2008). "Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery?". Ann Thorac Surg. 85 (2): 513–9. doi:10.1016/j.athoracsur.2007.08.056. PMID 18222254.
  22. ↑ Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK; et al. (2008). "The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients". Ann Thorac Surg. 85 (2): 548–53. doi:10.1016/j.athoracsur.2007.08.061. PMID 18222262.
  23. ↑ Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L; et al. (2006). "The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke". Eur J Cardiothorac Surg. 29 (5): 720–8. doi:10.1016/j.ejcts.2006.02.001. PMID 16522368.
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