Feit A, Reddy C V, Cowley C, Ibrahim B, Zisbrod Z
Department of Medicine, State University of New York Health Science Center, Brooklyn 11203.
Cathet Cardiovasc Diagn. 1992 Feb;25(2):85-90. doi: 10.1002/ccd.1810250202.
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.
在130例因冠状动脉造影结果提示可能将左乳内动脉（LIMA）用作旁路移植的患者中，同步进行了LIMA血管造影和诊断性冠状动脉造影。在98%的病例中，LIMA血管造影采用经股动脉途径，使用5F LIMA导管，先将其插入近端锁骨下动脉，然后沿置于锁骨下动脉远端、LIMA起始部之外的导丝推进。拔出导丝后，将导管回撤至近端，用非离子型造影剂选择性地插入LIMA并进行显影。唯一的并发症是1例短暂性枕叶视野缺损。发现2例LIMA管径过窄无法用作移植血管，1例LIMA闭塞与既往手术无关，2例LIMA闭塞与既往手术有关。5例存在锁骨下和/或椎动脉狭窄。术前能很好识别的LIMA大的近端分支有12例。基于这一经验，LIMA血管造影1）可以安全且高度成功地进行，2）在15%的病例中显示出重要发现，3）因此，只要冠状动脉造影结果表明适合考虑将LIMA用于冠状动脉旁路移植术，就应进行LIMA血管造影。
