LIMA to LAD coronary bypass graft (CABG)

LIMA to LAD coronary bypass graft (CABG)

LIMA to LAD coronary bypass graft: LIMA (left internal mammary artery) is to date the most durable conduit for coronary artery bypass grafting. It has stood the test of time as the best graft for a coronary artery, being a live arterial graft with very little likelihood for atherosclerotic lesions. Here the LIMA graft is imaged in the lateral view. The image has been darkened a bit by post processing to visualize the LIMA and LAD (left anterior descending coronary artery) well. Since it was an injection into the left subclavian artery just near the LIMA ostium, the contrast density was a bit lower than that of a superselective LIMA injection. The sternal wires indicate the post sternotomy status. Distal flow into the LAD is good even after one and a half decades. Retrograde flow from the anastomotic site into the proximal part of LAD is also seen.

There are specialized catheters available for direct cannulation of the left internal mammary artery. But usually either a Tiger catheter (transradial) or a Judkins right coronary catheter are used for non selectively injecting into the left subclavian artery. Compression of the left brachial artery during the injection will reduce the flow to the left upper limb and enhance flow into the LIMA.

In a study of 130 cases, they used 5F LIMA catheter which was initially directed to left subclavian artery and then advanced over a guidewire for superselective LIMA cannulation [1].

Reference

1. Feit A, Reddy CV, Cowley C, Ibrahim B, Zisbrod Z. Internal mammary artery angiography should be a routine component of diagnostic coronary angiography. Cathet Cardiovasc Diagn. 1992 Feb;25(2):85-90.