title: Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it?
abstract: Atherosclerotic subclavian artery disease is detected in about 5% of patients referred for coronary artery bypass (CABG) surgery. The internal mammary artery, a branch of the subclavian artery, is the most frequently utilized graft to restore coronary circulation because of its longevity. Stenosis or occlusion of the subclavian artery can cause retrograde blood flow in the ipsilateral internal mammary artery, known as "steal," compromising coronary circulation supplied by the graft. Steal may be asymptomatic or may result in symptoms of myocardial ischemia. Symptomatic subclavian artery stenosis post bypass is referred to as coronary subclavian steal syndrome post-CABG. The incidence is not well defined, and the benefits of screening patients referred for CABG are not known. Despite the various modalities available to detect subclavian artery stenosis, current guidelines fail to provide guidance about screening high-risk patients for this entity. Detection of subclavian artery disease prior to CABG can reduce complications posed by post-mammary artery graft cardiac ischemia. This review discusses the utility of preoperative subclavian artery screening prior to CABG.
authors.affiliation: Cardiology Division, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.|Division of Cardiovascular Medicine, The University of Toledo College of Medicine and Life Science, Toledo, OH, USA.|John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: Ali
authors.identifier: http://orcid.org/0000-0002-6221-6283
authors.initials: A
authors.lastname: Abdul Jabbar
authors.affiliation: Cardiology Division, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Houston
authors.affiliation: Division of Cardiovascular Medicine, The University of Toledo College of Medicine and Life Science, Toledo, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Burket
authors.affiliation: Cardiology Division, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Il'Giovine
authors.affiliation: Cardiology Division, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Bal K
authors.initials: BK
authors.lastname: Srivastava
authors.affiliation: Cardiology Division, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.|Cardiology Division, Department of Medicine, Dayton VA Medical Center, Dayton, OH, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D001026:Coronary Artery Bypass; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D013349:Subclavian Steal Syndrome / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*
keywords: angiography; coronary artery bypass graft surgery; doppler echocardiography