Name of the Procedure:

Angiography, Internal Mammary
(Common names: Internal Mammary Artery Angiography, IMA Angiography)

Summary

Internal mammary angiography is an imaging procedure that uses X-rays to visualize the internal mammary arteries. This is done by injecting a contrast dye into the arteries to make them visible on the X-ray images. Radiological supervision and interpretation ensure that the images are accurately captured and analyzed.

Purpose

This procedure is primarily conducted to assess the condition of the internal mammary arteries, which can be crucial for patients undergoing coronary artery bypass surgery. By evaluating these arteries, doctors can determine their suitability as grafts for bypass surgery. It also helps in diagnosing certain types of chest pain or blood vessel problems.

Indications

• Symptoms/Conditions: Chest pain, suspected coronary artery disease, preparation for coronary artery bypass surgery.
• Patient Criteria: Patients who need evaluation of the internal mammary arteries, those with symptoms suggestive of vascular issues, or individuals preparing for cardiac surgeries.

Preparation

• Pre-procedure Instructions: Patients may be asked to fast for several hours before the procedure. They should inform their healthcare provider of any allergies, especially to contrast dye or iodine, and provide a list of current medications.
• Pre-procedure Tests: Basic blood work, kidney function tests, and an electrocardiogram (ECG) may be required beforehand.

Procedure Description

1. Preparation: The patient is positioned on an X-ray table and connected to monitoring equipment to keep track of heart rate and blood pressure.
2. Anesthesia/Sedation: Local anesthesia is applied at the site where the catheter will be inserted, usually the groin or arm. Sedation may be administered for patient comfort.
3. Insertion: A catheter (a thin, flexible tube) is inserted into the blood vessel and guided to the internal mammary artery.
4. Contrast Injection: Once in place, a contrast dye is injected through the catheter into the artery.
5. Imaging: X-ray images are taken as the dye flows through the artery, which helps in visualizing any blockages or abnormalities.
6. Completion: The catheter is removed, and pressure is applied to the insertion site to prevent bleeding.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, specifically in a cardiac catheterization lab or an interventional radiology suite.

Personnel

• Primary Professionals: Interventional radiologist or cardiologist.
• Supporting Staff: Nurses, radiologic technologists, anesthesiologists (if sedation is used).

Risks and Complications

• Common Risks: Bruising or bleeding at the insertion site, allergic reactions to contrast dye.
• Rare Complications: Infection, damage to the artery, kidney dysfunction due to contrast dye, and very rarely, stroke or heart attack.

Benefits

• Expected Benefits: Accurate assessment of the internal mammary arteries, better planning for coronary artery bypass surgery, and effective diagnosis of vascular conditions.
• Realization Time: Benefits are immediate in terms of diagnostic information obtained during the procedure.

Recovery

• Post-procedure Care: Patients may need to lie flat for a few hours to prevent bleeding at the insertion site. They are usually monitored for several hours before being discharged.
• Recovery Time: Most patients can resume normal activities within a day, but heavy lifting and strenuous activities should be avoided for a few days.
• Follow-up: Instructions regarding wound care and any necessary follow-up appointments will be provided before discharge.

Alternatives

• Non-invasive Alternatives: CT angiography or MR angiography.
• Pros and Cons: These alternatives may be less invasive but might not provide as detailed images as traditional angiography. They also may not be suitable for all patients, depending on the specific medical condition being evaluated.

Patient Experience

• During Procedure: Patients may feel a slight pressure or discomfort at the catheter insertion site, and a warm sensation when the dye is injected.
• After Procedure: Mild soreness or bruising at the insertion site. Pain management may include over-the-counter pain relievers and instructions for keeping the site clean and dry.