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Post Coronary Bypass Surgery Angiography and Interventions

posted on 2022-10-18, 17:05 authored by M. Reza Movahed

Patient Selection

Coronary angiography in the setting of coronary artery bypass grafting (CABG) is important diagnostic tool for the evaluation of bypass graft patency in patients presenting with angina or ischemia. Furthermore, coronary interventions in diseased vein grafts are common practice for the treatment of graft atherosclerosis. Angiography in the setting of CABG is more complex and challenging. Before the vein graft angiography is performed, it is very helpful to have the operative report available. It will assist the angiographer to know the exact number and anatomical features of the vein grafts. At least the types and number of vein grafts should be available before pursuing with angiogram. It can substantially decrease radiation exposure, procedural time, contrast use and the risk to the patient. For example, the knowledge about lack of internal mammary artery (IMA) utilization as a bypass graft conduit will eliminate the need for left or right subclavian artery catheterization with reduction in the risk, radiation exposure and contrast use. Available information about the number of grafts will eliminate the search for unknown number of grafts. It is important to know if the right coronary artery was grafted. Vein grafts to the right coronary arteries have usually right-sided take off from the aorta while left coronary grafts usually have an anterior take off. Sequential vein grafts supplying two coronaries with one vein graft are not uncommon. Therefore, the knowledge about the presence of sequential vein grafts will aid the angiographer to avoid searching for additional non existing vein graft ostium

The indication for performing coronary and vein graft angiography in patients with CABG is similar to the patients without bypass surgery. Unstable or symptomatic patients, who are candidates for coronary intervention, should undergo this procedure. Asymptomatic patients with a large area of ischemia, particularly with the new onset of left ventricular dysfunction or congestive heart failure, may benefit from angiography and intervention. It is important to discuss higher use of contrast and longer procedural time with the patient. Other limitations of coronary angiography are similar to the patients undergoing native coronary angiography. Patients with risk of bleeding, infection, peripheral vascular disease, renal failure, anemia, coagulopathy, congestive heart failure and significant co-morbid conditions are at higher risk for complications. It is important that the patient agrees to undergo revascularization if deemed necessary before pursuing with angiography.

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