Nonselective preoperative digital subtraction angiography of internal mammary arteries

Abstract

In preparation for coronary bypass surgery, digital subtraction angiography (DSA) was used to assess the caliber of the left and right internal mammary arteries and to exclude stenoses of their feeding arteries. In 100 patients (86 males, mean age 56 +/- 9 years) DSA was performed with a Siemens Digitron 2 device. A frontal projection was used in 18 patients, and a 10-20 degree right anterior oblique projection was used in 82 patients. The flow was 10 to 25 ml/sec; 20 ml was injected in 45 patients, 30 ml in 41, 40 ml in 5, 50 ml in 8, and 60 ml in 1 patient. Judged on the proximal third, visualization of the left and the right internal mammary artery was good in 80 and 72, fair in 17 and 20, and bad in 3 and 8 arteries, respectively. The diameter (mm) was 2.7 +/- 0.4 (range 1.8-3.4) and 2.7 +/- 0.3 (range 2.0-3.5), and visible length (cm) was 8 +/- 5 (range 1-24) and 9 +/- 4 (range 2-22) for the two arteries, respectively. The 10-20 degree right anterior oblique view separated the left internal mammary artery better from the descending aorta than the frontal view. In more pronounced right anterior oblique views the ascending aorta interfered with the right internal mammary artery. The quality was not different with 20 ml or 30 ml injections. The feeding arteries could not be assessed in 4 patients. One left subclavian artery was found occluded at the orifice. Incidentally, 2 distal right subclavian stenoses and 2 carotid stenoses were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Malpractice in Invasive Cardiology: Is Angiography of Abdominal Aorta or Subclavian Artery Appropriate in Patients Undergoing Coronary Angiography?

“…Proximal subclavian artery occlusive disease in the presence of a patent internal mammary artery used as a conduit for a coronary artery bypass graft procedure may cause the reversal of the internal mammary artery flow (coronary-subclavian steal) leading to myocardial ischemia [12,[37][38][39]. Visualization of the subclavian artery by duplex ultrasound is possibly in nearly all cases at least for the distal part of the vessel.…”

Vascular profile of patients with multivessel coronary artery disease

“…Patients with these findings or with evidence of diffuse atherosclerotic vascular disease should have brachiocephalic arteriography at the time of coronary arteriography to identify significant subclavian artery occlusive disease. Moreover although very unusual, atherosclerotic lesions of the internal mammary artery have been reported in patients undergoing coronary angiography [6][7][8][9]. Angiography of subclavian artery and internal mammary artery at the time of coronary angiography seems effective in preventing any coronary-subclavian steal syndrome and in assessing the suitability of LIMA as a bypass conduit as well, and it is more effective in patients with upper extremity and cerebrovascular ischemia, cervical or supraclavicular bruits, and an upper extremity blood pressure differential of 20 mm Hg or greater, previous thoracic or neck brachitherapy or thoracic surgery.…”

Bilateral selective internal mammary artery angiography via right radial approach: Clinical experience with newly designed Yumiko catheter

“…The using of soft catheter tip by a Yumiko catheter can be a solution to this problem. Nonselective IMA angiogram by hand or power injection in the ascending aorta near the subclavian artery [3] and a new balloon-tipped catheter [14] or digital subtraction angiogram [15] can also be used as well as in our previous report of nonselective left IMA angiography by using 5 Fr Judkins 3.5 catheter during the diagnostic coronary angiography [16].…”