A Case Report of Coronary Subclavian Steal Syndrome in a Young Woman

Abstract

A 41-year-old woman presented with complaints of increasing angina pectoris and coldness of her left arm for 1 month. Six months ago, she had undergone triple coronary artery bypass grafting (CABG) including left internal mammary artery (LIMA) to left anterior descending artery (LAD) and two saphenous vein grafts to the diagonal branch of LAD and obtuse marginal branch of the circumflex artery. Coronary angiography revealed that contrast media injected into the saphenous vein graft coursing down the diagonal branch flowed up to LAD and drained into the LIMA opacifying the left subclavian artery. Arch angiography documented a total occlusion of the left subclavian artery. A polytetrafluoroethylene graft was anastomosed between the left common carotid and axillary artery. After operation, the symptoms disappeared and blood pressure in her left arm recovered. This complication could be prevented by identification of subclavian artery stenosis during coronary angiogram or CABG. This study may suggest that subclavian artery angiography should be performed in patients who will undergo CABG even for a young woman such as our case.

Cuff occlusion on the left upper arm increases flow of the left internal mammary artery and bypass flow to the left anterior descending artery

“…The reduction of LIMA fl ow was augmented by shifting the blood fl ow to the vertebral artery in restrictive fl ow. Several reports have been published suggesting that subclavian artery stenosis or occlusion could cause angina after CABG in patients with coronary subclavian steal syndrome [3][4][5][6][7][8]. There was no stenosis or occlusion of the subclavian artery in our patients, and LIMA blood fl ow and LIMA-LADA bypass fl ow did not decrease below the preocclusion value following the release of brachial artery occlusion.…”

Coronary ischemia due to subclavian stenosis after arterial revascularization

“…3 There are different approaches to treating coronarysubclavian steal. [2][3][4] Surgery with either carotidsubclavian bypass or subclavian-carotid transposition has a mortality rate of 1%-2%. 4,6 Angioplasty and stenting are either not amenable because of the risk of restenosis or contraindicated due to anatomical characteristics.…”

“…Coronary-subclavian steal is an uncommon phenomenon in which coronary flow is diverted to the subclavian artery through a patent ITA graft. 2 This occurs in cases of critical subclavian origin stenosis. Critical presentation occurs when left anterior descending coronary artery flow is based on the ipsilateral ITA.…”

“…Stenosis of the subclavian artery is a possible cause of ischemia due to coronary-subclavian steal. [1][2][3][4][5] The pathological mechanism is stealing of blood from the vertebral artery or internal thoracic artery (ITA) when used as an in-situ graft. Right subclavian steal syndrome is rare because of the anatomy of the artery.…”

“…The incidence of a left steal phenomenon ranges between 0.1% and 0.2%. 2,5 Peripheral symptoms are claudication, fatigue, and coldness of the left hand. Neurological symptoms include vertigo, imbalance, falling attacks, and dizziness.…”