title: Complete occlusion of the proximal subclavian artery post-CABG: presentation and treatment.
abstract: Atherosclerotic disease of the proximal left subclavian artery is an uncommon cause of angina in the post-coronary artery bypass graft patient, and is termed coronary-subclavian steal syndrome. Typical manifestations include cardiac symptoms of angina and noncardiac symptoms of lightheadedness, left arm numbness or weakness, and a difference in blood pressure of more than 20 mmHg between both arms. A case of complete proximal occlusion of the subclavian artery is reported. The clinical picture, investigations and treatment are described. Historical treatments of occlusive disease include surgical bypass graft and, more recently, percutaneous transluminal angioplasty. The patient underwent percutaneous transluminal angioplasty with stenting by a retrograde approach, with an excellent short-term response, but ultimately required a carotid subclavian bypass due to restenosis.
authors.affiliation: Department of Cardiology, St. Michael's Hospital, Toronto, Canada.
authors.forename: Mouhannad M
authors.initials: MM
authors.lastname: Sadek
authors.forename: Aravindhan
authors.initials: A
authors.lastname: Ravindran
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Marcuzzi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Chisholm
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery