Occluded left internal mammary artery (LIMA) graft

Occluded left internal mammary artery (LIMA) graft

Left subclavian artery injection showing left vertebral artery and left internal mammary artery. The LIMA had been grafted to left anterior descending coronary artery earlier, but is seen to be filling faintly only in the proximal part. The distal part has been occluded totally. The clips placed along the artery are seen as small opaque linear shadows along the track of the artery.

The catheter has been introduced into the aorta by the transfemoral arterial route. Sternal wires are visible on the left side of the image indicating previous sternotomy closure following coronary artery bypass graft. In an occasional case, one might find that the LIMA had been tied off after harvesting as it was technically not feasible to graft it. In that case we would not expect the clips to be seen all along the track down to the potential site of LAD anastomosis.