Coronary artery bypass surgery angiography


 * Associate Editors-in-Chief:, Mohammed A. Sbeih, M.D.[mailto:msbeih@perfuse.org]

Prior to coronary artery bypass grafting
It is often recommended that the first procedure performed on the diagnostic coronary angiography is the RAO caudal, to determine and to assess the stenosis in the circumflex, the left anterior descending, and distal targets. These are assessed in case the patient becomes critically ill following the initial injection in the left main. If the patient is not critically ill, then angiography should be performed in an adequate number of views to identify all blockages that should be bypassed as well as the size, calcification, and disease extent of target vessels. Angiography should continue for a sufficient duration of time to assess the presence and quality of distal vessels that may be collateralized and may need to be bypassed. Although left ventriculography is helpful in the assessment of left ventricular function, it can also be assessed on echocardiography to minimize the dye load and the potential for hemodynamic collapse with excess contrast agent.

Following coronary artery bypass grafting
Use of radio-opaque saphenous vein graft markers has been associated with the following in non-randomized observational studies:
 * 1) Reduced volume of contrast injections
 * 2) Shorter cardiac catheterization procedure times
 * 3) Greater rates of identification of occluded SVGs (90.7% vs 72.1%, p < 0.001)
 * 4) No increase in the risk of SVG failure
 * 5) An unexplained increase in the risk of perioperative MI in non-randomized analyses
 * 6) No increase in the risk of death or MI by 12-18 months of follow-up.