Diagnosis and management of the coronary-subclavian steal syndrome.
A patient is presented with recurrent angina due to a coronary-subclavian steal syndrome 3 years after left internal mammary to left anterior descending coronary artery bypass grafting. Myocardial ischaemia could easily be provoked by selective exercise of the left upper limb. Coronary angiography showed reversal of flow in the left internal mammary artery. Suggestions are given for prevention of the coronary-subclavian steal syndrome by identification of patients who are at risk of developing subclavian artery occlusive disease. Performance of coronary and brachiocephalic angiography is indicated in recurrence of angina in patients with internal mammary artery bypass grafts. Doppler spectral analysis may be a valuable technique for detection of a haemodynamically significant stenosis of the left subclavian artery. Carotid-subclavian bypass grafting is the procedure of choice for management of the coronary-subclavian steal syndrome.
Van Son
J A
JA
Department of Cardiothoracic Surgery, University Hospital Nijmegen, The Netherlands.
Aengevaeren
W R
WR
Skotnicki
S H
SH
Barentsz
J O
JO
van de Wal
H J
HJ
Buskens
F G
FG
D000787:Angina Pectoris / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D000792:Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008323:Mammary Arteries; D008875:Middle Aged; D012008:Recurrence; D013349:Subclavian Steal Syndrome / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D013895:Thoracic Arteries; D014463:Ultrasonography