Krishna Prasad Irniraya
Bombay Hospital Institute of Medical Sciences, India
Title: RIMA – LIMA ‘Y’ grafting - An alternative method of total arterial grafting
Biography
Biography: Krishna Prasad Irniraya
Abstract
For total arterial grafting in CABG, the usual conduits used are the bilateral Internal Mammary Arteries i.e., LIMA & RIMA. Usually LIMA is used as a pedicle graft and the free RIMA on it to make the LIMA – RIMA ‘Y’ composite grafting. The LIMA stem is used to graft the LAD & Diagonal branches; whereas the RIMA stem is used to graft the OMs, PLB & PDA branches.
But in certain situations where the Pedicle LIMA cannot be used for e.g. in case of left Subclavian Artery stenosis, total arterial grafting can still be accomplished by certain modifications.
Instead of pedicle LIMA, RIMA pedicle to be used and the free LIMA onto it making the RIMA – LIMA ‘Y’ composite grafting. Here the RIMA stem is used to graft the LAD and the LIMA stem is used to graft the Diagonal, OMs, PLB & PDA branches. So complete arterial grafting can still be achieved.
Not only total arterial grafting can be achieved, we can avoid handling of the aorta for the proximal anastomosis when vein or radial artery conduits are used. There are certain situations where we need to use RIMA – LIMA ‘Y’ Grafting instead of LIMA – RIMA ‘Y’. So the indications, advantages & technical issues will be discussed.