Post-CABG evaluation - competitive flow issues

This 42-years old man had an LAD lesion, along with a proximal CX lesion, for which a LIMA-LAD and a radial-OM1 grafts were performed.

The LIMA-LAD (Figs. 1, 2) is thin and stringy. The LAD on this study is actually seen to be patent, with no significant abnormality. We could not trace the original angiogram, but with no significant LAD lesion currently, the LIMA graft has to compete with normal flow through the LAD, as a result of which, it is seen to be extremely thin, probably due to minimal to and fro flow. The radial-OM1 graft is normal and patent (Figs. 2, 3).