Internal mammary arteriography: a new catheter technique by right brachial approach

A technique for catheterization of both internal mammary arteries (IMAs) by right brachial approach is described. A special preformed catheter was used in 75 patients with coronary artery disease, including ten patients with direct IMA grafts. No complications occurred. The IMAs were studied to examine the question of their usefulness in direct myocardial revascularization. There were individual variations in the size of IMAS with poor correlation to age (r = -0.432)) and body surface area (r = 0.517). Seventy percent of the women had adequate IMAs. The IMA diameter was equal to or larger than the left anterior descending coronary artery (LAD) in 72% and the right coronary artery (RCA) in 34% of comparisons. Of the ten patients with direct IMA grafts, three instances of large side branches were seen. These branches appeared to carry large flows at the expense of the grafted coronary artery. Preoperative internal mammary arteriography should be done if the use of this vessel is contemplated in direct myocardial revascularization to assure the use of an IMA of adequate caliber compared to the recipient coronary artery. The side branches should be meticulously ligated during the operation.