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J Thorac Cardiovasc Surg 2008;135:438-439
© 2008 The American Association for Thoracic Surgery

Brief Communication

Progressive subclavian artery stenosis causing late coronary artery bypass graft failure as a result of coronary–subclavian artery steal

Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Received for publication September 24, 2007; accepted for publication October 22, 2007.

^_* Address for reprints: Sanjay Theodore, MCh, Registrar, Cardiothoracic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria, 3050, Australia. (Email: sanjayawake@gmail.com).

The first 20% of the full text of this article appears below.

Proximal stenosis of the subclavian artery is known to cause ischemia in patients with a left internal thoracic artery (LITA) graft by stealing blood from the coronary circulation into the subclavian and axillary arteries.¹ Use of an in situ pedicled internal thoracic artery graft when the subclavian artery is proximally stenosed is contraindicated. We describe a case in which subclavian occlusion developed insidiously over 4 years, resulting in late-onset angina from a subclavian–coronary artery steal.

Clinical Summary

A 57-year-old man underwent coronary artery bypass grafting for left main double-vessel disease; he had a LITA graft to the left anterior descending coronary artery (LAD), a Y radial artery graft to the first diagonal coronary artery, and a left radial artery graft to the obtuse marginal artery. The patient smoked and was hypertensive and hypercholesterolemic, with no history of peripheral vascular disease.

The patient's postoperative course was uneventful. Four years later, he came to the emergency department with sustained ventricular tachycardia and unstable angina. Echocardiography revealed a grade III ventricle . . . [Full Text of this Article]

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				C. Zebele, H. I. Ozdemir, and M. A. S. Hamad Coronary ischemia due to subclavian stenosis after arterial revascularization Asian Cardiovasc Thorac Ann, April 1, 2011; 19(2): 169 - 171. [Abstract] [Full Text] [PDF]