Ultrasonography of the LIMA graft

Coronary artery bypass grafting (CABG) is a surgical procedure that has been in existence since 1967 [1]. Over the years, the use of the left internal mammary artery (LIMA), has been shown to be the conduit of choice for single or sequential bypass grafting to the anterior wall of the heart because of its long-term patency [2-10]. The LIMA originates from the stem of the concave side of the subclavian artery opposite the vertebral artery. It runs behind the cartilage of the first rib via the pleura to the front wall of the thorax and descends 1-2 cm from the lateral edge of the sternum. This anatomy of the LIMA graft allows easy visualisation by supraclavicular or transthoracic ultrasonography. Long term follow up has shown not only superior patency of the LIMA graft but also reduced mortality and angina and increased freedom from late cardiac events [5]. The success of the artery as a bypass conduit is partly caused by its dynamic capacity to dilate in response to increased blood flow and the relative resistance to atherothrombotic occlusion. Due to these excellent long term results it has been hypothesized that exclusive arterial (composite) grafts also would result in improved long term patency and is therefore nowadays an preferred method for coronary revascularization [11-14].

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