The clinical benefits of using the left internal mammary artery (LIMA) to bypass the left anterior descending artery are well established making it the most frequently used conduit for coronary artery bypass surgery (CABG). Coronary subclavian steal syndrome (CSSS) occurs during left arm exertion when (1) the LIMA is used during bypass surgery and (2) there is a high grade (≥75%) left subclavian artery stenosis or occlusion proximal to the ostia of the LIMA resulting in "stealing" of the myocardial blood supply via retrograde flow up the LIMA graft to maintain left upper extremity perfusion. Although CSSS was once thought to be a rare phenomenon, its prevalence has been underestimated and is becoming increasingly recognized as a serious threat to the success of CABG. Current guidelines are lacking on recommendations for screening of subclavian artery stenosis (SAS) pre- and post-CABG. We hope to provide an algorithm for SAS screening to prevent CSSS in internal mammary artery bypass recipients and review treatment options in the percutaneous era.

Aorto-iliac (Ao-I) disease is quite prevalent and leads to significant limitation in functional status and quality of life. Advances in endovascular therapy (EVT) techniques in the last 25 years, low risk of periprocedural complications and excellent long-term patency have made it possible to treat most symptomatic patients with Ao-I disease using an endovascular-first rather than a surgical approach in addition to guidelines-directed medical therapy. The approach to intra-procedural assessment of Ao-I lesions has evolved over time to include pressure gradient measurement and intravascular imaging. In 2017, the Society for Cardiovascular Angiography and Interventions (SCAI) published an update to the Appropriate Use Criteria (AUC) for EVT in the Ao-I, femoral-popliteal (FP), infra-popliteal and renal arterial circulations. 1 In 2018, a multi-societal AUC document for EVT was released by the

There is limited data to support endovascular treatment of isolated CFA atherosclerosis. CFE has durable results, but there is significant morbidity and mortality resulting from this procedure. Endovascular interventions have low rates of complications, high rates of technical success, good short-term patency but increased need for repeat interventions when compared to surgery. Further trial data comparing CFE with endovascular therapy is needed to guide the management of CFA stenosis.

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