LIMA is a critical conduit for CABG.It is the most suitable vessel for CABG for various reasons.(Radial artery falls far short of expectations due to anatomical and histological , physiological reasons !)
Anatomical variations , kinks and bends , loops are more common in LIMA than we recognise.This may not have major implication but can be threat to it’s hemodynamic superiority .
This man who had a two loops in LIMA and the one above almost tied a knot .(Please note it is an end on view of a loop that mimic a knot )
Can a surgeon un-do the loop before grafting ?
It may be possible in the distal ends where the LIMA is dissected out. I dont think it would be possible high up.
Surgeons should answer this . . .
Dr.S.Venkatesan MD 
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