Internal mammary artery angiography should be a routine component of diagnostic coronary angiography

Abstract

Left internal mammary artery (LIMA) angiography was performed with diagnostic coronary angiography in 130 cases for which the coronary findings made use of the LIMA as a bypass graft a consideration. In 98% of the cases the approach to LIMA angiography was femoral with a 5F LIMA catheter first directed into the proximal subclavian and then advanced over a guidewire placed into the distal subclavian well beyond the origin of the LIMA. After withdrawing the wire the catheter was brought proximally to selectively cannulate and visualize the LIMA with nonionic contrast media. The only complication was a single transient occipital visual field loss. LIMA caliber too narrow to permit use as a graft was found twice, LIMA occlusion unrelated to prior surgery was found once, and LIMA occlusion related to prior surgery was found twice. Subclavian and/or vertebral stenosis was present five times. Large proximal branches of the LIMA best identified prior to surgery were present 12 times. Based on this experience, LIMA angiography 1) can be performed safely with a high degree of success, 2) demonstrates significant findings in 15% of cases, and 3) should therefore be performed whenever coronary angiographic findings make it appropriate to consider LIMA to coronary artery bypass grafting.

Anomalous origin of left internal mammary artery from the lateral junction of the left subclavian artery and aorta

“…In the study by Feit et al [2], there was one complication consisting of a transient occipital visual field loss in a 75-year-old hypertensive female. There were no complications reported in the study by Bauer et al [ …”

“…[2] performed left internal mammary artery angiography in 130 patients, with significant findings in 15% of cases. Between 4-5% of native internal mammary arteries were found to be unacceptable for surgery.…”

Abnormal Origin of the Left Internal Thoracic Artery Detected Only by Computed Tomography

“…Finally, patients who are being evaluated for repeat CABG may have had damage to the ITA during their previous procedure. Feit et al noted two instances in their study in which the ITA had been cut off or snared in the wire sutures from a previous bypass procedure, rendering it unusable as a graft (16).…”

“…Feit et al recommend making ITA angiography a routine part of a diagnostic coronary angiography once the patient has been deemed a surgical candidate, as signifi cant fi ndings occurred in 15% of cases (16). A similar study by Bauer et al revealed surgically signifi cant fi ndings in 30% of patients, 4% to 5% of which required modifi cation of surgical strategy (17).…”

Anomalous Origin of Left Internal Thoracic Artery from the Second Intercostal Artery

“…In 4% of patients, modification of surgical strategy was required. Feit et al (1992) performed LITA angiography in 130 patients, with significant findings in 15% of cases. Between 4-5% of native ITA were found to be unacceptable for surgery.…”