Bypass graft angiography: a Cath Lab 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Bypass graft angiography in one minute
What it is: an angiogram for people who have had heart bypass surgery (CABG): X-ray pictures of the grafts as well as the heart's own arteries.
Who it is for: people with bypass grafts who have new chest pain, a heart attack, or a positive stress test.
Main risks: bruising at the wrist or groin, reactions to the dye, and rarely damage to an artery or graft, heart attack or stroke.
Usually: under local anaesthetic, often a little longer than a standard angiogram, home the same day.
On this page: What is bypass graft angiography? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in the lab? · FAQ
Bypass grafts filled with contrast.
What is bypass graft angiography?
During bypass surgery, blood vessels are used to carry blood around narrowed heart arteries. These are called grafts:
- arterial grafts, often the internal mammary artery from inside the chest wall
- vein grafts, often from the leg, attached to the aorta
In graft angiography, the team finds the start of each graft with a shaped catheter and injects contrast dye to see whether it is open or narrowed. The surgical notes, or a marker on the aorta, help to find each graft.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- new or returning chest pain after bypass surgery
- a heart attack after bypass surgery
- a positive stress test or scan
- planning further treatment such as graft or native artery stenting
The decision is made by your heart team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It can be planned in advance or done urgently. Before it, you usually have:
- blood tests, including kidney function and blood count
- an ECG, and often an echo or other scan
- a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
- a chance to ask questions and give consent
Before the procedure: tests and consent, medicine advice, checks on the day, then the cath lab.
Step by step
1. Getting ready
You lie on the X-ray table. ECG, blood pressure and oxygen levels are monitored. The skin over the access site is cleaned and numbed with local anaesthetic; some people also have light sedation, as per centre protocol.
2. Access
A sheath is placed in the radial artery or the femoral artery. The left radial is sometimes used to reach a left internal mammary graft. Sizes per device and operator.
Access: Catheter at the bypass grafts; Aorta; Sheath in right femoral artery.
3. Finding the grafts
- A. Native arteries. The heart's own coronary arteries are imaged first.
- B. Vein grafts. Shaped catheters find each vein graft on the aorta, guided by the surgical notes.
- C. Mammary graft. A dedicated catheter is placed in the internal mammary artery.
- D. Review. The team checks every graft is accounted for.
A: native arteries. B: vein grafts. C: mammary graft. D: review.
4. Finishing
The catheters are removed. The sheath is taken out and the site closed with pressure, a band or a closure device, per device and operator.
Recovery and aftercare
- First hours: you rest while the nurses check the access site, pulse and blood pressure, as per centre protocol.
- Going home: usually the same day, with someone to take you home.
- Access site: avoid heavy lifting and strenuous activity for a few days; a small bruise is common.
- Results: the team will usually explain the findings before you go home, and send a report to your own doctor.
- Driving: ask your team; for a planned test it is often a couple of days, but it depends on your heart condition.
Call 999 if you have chest pain, breathlessness, fainting, signs of a stroke, or heavy bleeding or swelling at the access site.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- bruising or bleeding at the access site (common, usually minor)
- damage to the artery or vein at the access site (uncommon)
- reaction to the contrast dye, or effects on kidney function
- heart rhythm disturbances, usually brief
- heart attack, stroke or serious complications (rare)
- X-ray exposure, kept as low as possible
Cath lab kit list (printable)
Barts example kit list
An example from one UK centre, written generically. Every lab has its own protocol, and sizes and doses vary.
- arterial sheath, size per device and operator
- standard and graft-shaped diagnostic catheters, per operator
- internal mammary catheter, per operator
- guidewires
- contrast, volume as per centre protocol
- heparin if radial, as per centre protocol
- surgical notes with graft details
Main kit (generic): Sheath; Guidewire; Graft catheter; Surgical notes.
Procedural steps (Barts example)
- Review operation notes: number and type of grafts
- Arterial access
- Native coronary angiogram
- Each vein graft engaged and imaged
- Internal mammary graft imaged
- All grafts accounted for; catheters out; haemostasis
After the procedure: (1) Site and rhythm checks; (2) Home for most; (3) Avoid heavy lifting; (4) Results and plan.
First time in the cath lab?
đź’ˇ First-time tip
- Get the op notes. Knowing the grafts saves time and dye.
- Count the grafts. Make sure every graft is found or explained.
- Watch the dye total. Graft studies use more contrast.
- Mammary catheter ready. Have it on the trolley.
FAQ
Why does it take longer?
The team must find each graft as well as the heart's own arteries.
What if a graft is blocked?
The team will discuss options such as stenting, medicines or surgery.
Is it safe after surgery?
Yes, it is routinely done after bypass surgery.
Related Cath Lab 101 guides
Sources
All checked on 10 October 2026. Each page's own date is shown where it gives one.
- Knuuti J, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41(3):407–477. PubMed 31504439
- Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44(38):3720–3826. PubMed 37622654
- NHS. Coronary angiography. nhs.uk/conditions/coronary-angiography
Disclaimer
Education only. This page is for general education for healthcare students, cath lab staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, heart team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a heart emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
