Graft control by transit time flow measurement and intraoperative angiography in coronary artery bypass surgery.

BACKGROUND: The aim of this study was to compare the relationship between intraoperative transit time flow measurements and angiographic findings with long-term graft patency in 72 patients who underwent coronary artery bypass surgery. METHODS: Transit time flow measurements with recording of mean flow and pulsatility indexes were performed after completion of the anastomoses. Coronary angiography was performed on-table while the patients were still in general anesthesia, and then at follow-up three months and 12 months after surgery. Based on angiography, the grafts were graded as type A (fully patent), type B (having more than 50% diameter reduction), or type O (occluded). RESULTS: Of the 67 left internal mammary artery (LIMA) grafts, 51 (76%) were type A on-table, 14 (21%) were type B, and two (3%) were type O. Of the 57 saphenous vein grafts, 49 (86%) were type A, 7 (12%) were type B, and one (2%) was type O. For both LIMA and vein grafts, there were no differences in flow (p = 0.69 and 0.47, respectively) or pulsatility index (p = 0.79 and 0.83) between type A and B. There were also no differences in flow (p = 0.37 and 0.7) or pulsatility index (p = 0.37 and 0.24) between type B on-table that either normalized or persisted occluded at the follow-up. Transit time flow measurement failed to detect an occluded LIMA graft as shown by intraoperative angiography. CONCLUSIONS: Blood flow measurements performed intraoperatively could not identify significant lesions in arterial or vein grafts, and could not predict graft patency. We have become cautious in interpreting flow measurements alone and combine blood flow recordings with intraoperative angiography in the assessment of graft quality.

AO tension-band osteosynthesis of displaced olecranon fractures.

This study reviewed 31 patients who underwent AO tension-band osteosynthesis of displaced olecranon fractures. Thirteen fractures were comminuted. Postoperative immobilization was short, and the median hospital stay was 3 days. In 2 patients, the stainless steel wire broke and required replacement. In 13 patients, the osteosynthesis material was removed after healing because of pain at the tip of the elbow; this did not influence the final result. Median time out of work was 12 weeks. There was no significant loss of elbow power. There was satisfactory mobility, function, and absence of pain. There were 29 good and 2 fair clinical results. Anatomic reduction was achieved in 24 elbows. Possible arthrosis was detected at follow-up in 5 elbows but these patients had a good clinical result. AO tension-band osteosynthesis of displaced olecranon fractures yields good clinical medium-term results with few serious complications.