--- title: How Zero Flow can Trigger Graft Revision in LIMA-Cx Grafts description: Check out these 2 case studies that demonstrate how important flow measurement is in determining the patency of a bypass graft. image: https://blog.transonic.com/hubfs/LIMA-Cx-graft.jpg --- [![Customer Login](https://no-cache.hubspot.com/cta/default/40716/9ebb5f25-e3e3-45fd-b525-1b9073c47d36.png)](https://cta-redirect.hubspot.com/cta/redirect/40716/9ebb5f25-e3e3-45fd-b525-1b9073c47d36) [![Transonic_logo-456](https://blog.transonic.com/hs-fs/hubfs/email-assets/newsletter/Transonic_logo-456.png?width=190&height=50&name=Transonic_logo-456.png "Transonic_logo-456")](https://www.transonic.com/) [![Talk with an Expert](https://no-cache.hubspot.com/cta/default/40716/44c87484-21b7-4747-832d-28806f592c2d.png)](https://cta-redirect.hubspot.com/cta/redirect/40716/44c87484-21b7-4747-832d-28806f592c2d) ![mail-icon](https://blog.transonic.com/hubfs/Transonic_2019/Images/mail-icon.png) ## Hear more from our team: - [** ](https://www.facebook.com/sharer/sharer.php?u=https://blog.transonic.com/cardiothoracic-surgery/zero-flow-trigger-graft-revision-lima-cx-grafts&title=How%20Zero%20Flow%20can%20Trigger%20Graft%20Revision%20in%20LIMA-Cx%20Grafts&picture=http://cdn2.hubspot.net/hubfs/40716/LIMA-Cx-graft.jpg&description=Check%20out%20these%202%20case%20studies%20that%20demonstrate%20how%20important%20flow%20measurement%20is%20in%20determining%20the%20patency%20of%20a%20bypass%20graft.) - [**](http://www.linkedin.com/shareArticle?mini=true&url=https://blog.transonic.com/cardiothoracic-surgery/zero-flow-trigger-graft-revision-lima-cx-grafts&title=How%20Zero%20Flow%20can%20Trigger%20Graft%20Revision%20in%20LIMA-Cx%20Grafts&summary=Check%20out%20these%202%20case%20studies%20that%20demonstrate%20how%20important%20flow%20measurement%20is%20in%20determining%20the%20patency%20of%20a%20bypass%20graft.) - - [**](mailto:?subjetc=&body=How+Zero+Flow+can+Trigger+Graft+Revision+in+LIMA-Cx+Grafts%20-%20https://blog.transonic.com/cardiothoracic-surgery/zero-flow-trigger-graft-revision-lima-cx-grafts) # How Zero Flow can Trigger Graft Revision in LIMA-Cx Grafts By [Susan Eymann, MS](https://blog.transonic.com/cardiothoracic-surgery/author/susan-eymann-ms)04 Nov 2015 The following two cases demonstrate how critical [flow measurement](https://blog.transonic.com/blog/can-you-afford-not-to-measure-coronary-artery-bypass-graft-cabg-flow) is in determining the patency of a bypass graft. The bypass grafts in each of the cases first measured 0 ml/min flow. Flow improved appreciably after revision of the grafts. ### Case No. 1 A 78-year-old female patient underwent single coronary bypass grafting to bypass a blocked circumflex (Cx) coronary artery with the LIMA bypass graft. Following anastomosis of the LIMA to the Cx distal to the blockage, flow measured 0 mL/min (PI: 91). The flow waveform had a spiky systolic profile (top waveform). Revision was demanded. Following revision of the graft, mean graft flow improved to 32 mL/min (PI: 2), and the waveform exhibited a balanced systolic/diastolic profile (bottom waveform). Zero mean flow was the determining factor in the decision to revise the graft. ![LIMA-Cx-graft](https://blog.transonic.com/hs-fs/hubfs/LIMA-Cx-graft.jpg?width=493&name=LIMA-Cx-graft.jpg) The top [waveform](https://blog.transonic.com/analysis-bypass-graft-waveform) exhibited a spiky systolic profile, which, accompanied by zero mean flow, called for the surgeon to revise the LIMA-Cx graft without hesitation. Flow improved to 32 mL/min after revision and the waveform exhibited a balanced LIMA-Cx profile (bottom waveform). ### Case No. 2 A 78-year-old male patient underwent OPCAB. The LIMA was used as a bypass to the Cx. Initial flow measured 0 mL/min and was accompanied with a systolic waveform profile. The graft was revised and flow increased to 32 mL/min. Flow exhibited a more balanced systolic/diastolic waveform (lower waveform). The PI went from 100 to 2. ![LIMA-Cx](https://blog.transonic.com/hs-fs/hubfs/LIMA-Cx.jpg?width=479&name=LIMA-Cx.jpg) The upper spiky systolic waveform profile shows initial 0 mL/min LIMA-Cx graft flow following anastomosis of the bypass. After the graft was revised, flow increased to 32 mL/min and was accompanied by a more balanced diastolic/systolic profile (lower waveform). 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