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Related Experiment Videos

Internal mammary artery anomalies.

E P Bauer1, M C Bino, L K von Segesser

  • 1Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.

The Thoracic and Cardiovascular Surgeon
|October 1, 1990
PubMed
Summary

Internal mammary artery (IMA) anomalies are common, affecting 30% of patients undergoing coronary artery bypass grafting (CABG). Pre-operative angiography can identify these anomalies, preventing potential complications and guiding surgical strategy for better outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Anatomy
  • Interventional Cardiology

Background:

  • The internal mammary artery (IMA) is the preferred conduit for coronary artery bypass grafting (CABG).
  • Anomalies in IMA anatomy can complicate surgical procedures and impact graft patency.
  • The actual incidence of surgically significant IMA anomalies is not well-established.

Purpose of the Study:

  • To determine the incidence of surgically significant anomalies of the internal mammary artery (IMA).
  • To assess the impact of pre-operative IMA angiography on surgical planning for coronary artery bypass grafting (CABG).

Main Methods:

  • Angiographic visualization of 524 IMAs in 262 consecutive patients scheduled for CABG.
  • Analysis of visualized IMAs for anomalies such as common origin, large side branches, tortuosity, atypical course, atherosclerotic lesions, and spasticity.

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  • Correlation of identified anomalies with modifications in surgical strategy and preparation.

    • Main Results:

    • A 26% incidence of surgically significant IMA anomalies was observed in 30% of patients.
    • Common anomalies included common origin (11%), large side branches (9%), and tortuosity (5%).
    • Pre-operative angiography led to surgical strategy modification in 4% of patients and necessitated meticulous preparation in 26% due to complex anatomy.

    Conclusions:

    • Significant IMA anomalies are relatively common and can go undetected during surgical take-down.
    • Pre-operative angiography during cardiac catheterization is crucial for diagnosing IMA anomalies.
    • Early detection of IMA anomalies can prevent compromised IMA flow after CABG and optimize surgical planning.