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On Tue, 10 Jun 1997, Joseph E. Zaweski wrote:

> --- Diane Shapiro wrote:
> I am looking for information on the scanning of internal mammary artery
> prior to bypass grafts: scanning protocol, scanning tips, color/Doppler
> expectations.
> --- end of quoted material ---
> We start at midline (sternum) at about the level of the 3rd intercostal space,
> slowly move laterally, either direction, and you should see the IMA between
> ribs at an inch or two lateral to midline.  It will be a few centimeters deep
> and the flow will be caudad.  We first take a Doppler waveform to assure that
> it is triphasic (enlarge the spectrum for evaluation), anything else is
> abnormal and should raise a red flag.  Second, we take a B-mode image and
> measure the diameter of the artery, it is a relatively small artery (2-5 mm).
> We do a bilateral study.
>
> Joe Zaweski
> Dartmouth-Hitchcock Medical Center
>

  I confer with above scanning of IMA; however, I highly recommend also
obtaining velocities in subclavian arteries, bilaterally.If these are
stenotic and then used for bypass, patient may still experience chest pain
after surgery or during exercise.
  Kellee Scott
  UVM-Vascular lab