A Case Report of Coronary-Subclavian Steal Syndrome Treated with Carotid to Axillary Artery Bypass

Abstract

Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. This rare complication of cardiac revascularisation leads to recurrence of myocardial ischaemia. When feasible, subclavian angioplasty and/or stent placement can provide acceptable result for these patients. Vascular reconstruction through carotid to subclavian artery bypass has been the standard procedure of choice. Other interventions in literature include axilloaxillary bypass and subclavian carotid transposition. This case report describes the use of carotid axillary artery bypass for the treatment of coronary-subclavian steal syndrome.

Carotid axillary artery bypass: an option following failed open and percutaneous procedures

“…Distal graft anastomosis to the axillary artery instead of the subclavian artery has also been employed to successfully treat symptomatic coronary–subclavian steal syndrome caused by proximal subclavian stenosis. 2 The result of this operation has been documented in a 10-year study of carotid–axillary bypasses in 26 patients with a graft patency rate of 96% and mean follow-up of 47months. 4 Table 1 summarizes reported axillary bypass procedures.…”

“…In contrast, infraclavicular exposure of the axillary artery is easier to dissect for anastomosis. 2 Nonetheless, the carotid–axillary bypass may be associated with a higher risk for brachial plexus nerve damage. In addition, care must also be taken to avoid vein injury.…”

Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient

“…The CSSS is a rare complication after CABG using the IMA, first described by Harjola and Valle in 1974 [ 13 ]. The incidence varies between 0.07 and 3.4%, early and late onsets (2–31 years after CABG) have been described [ 10 ]. The most common cause is a stenosis or an occlusion of the left SA proximal to the origin of the LIMA graft, leading to a flow reversal and MIS after strain of the left arm [ 10 ].…”

“…Due to an incidence of SA stenoses of up to 2.7% in patients requiring CABG surgery and the increased use of the IMA as a CABG-conduit, a standardized preoperative screening of these patients for SA stenoses before undergoing CABG surgery using the IMA has been repeatedly recommended [ 1 , 11 , 12 ]. In the case of a SA stenosis, a simultaneous therapy performing the CABG and an interventional or surgical therapy for the SA lesion should be considered [ 10 ]. The clinical presentations vary from an asymptomatic steal phenomenon to silent ischemia [ 1 , 10 , 12 , 14 ], unspecific cardiac symptoms [ 4 ], rarely different forms of MIN [ 8 ] or even heart failure [ 10 ].…”

“…The diagnosis may be provided by Doppler and/or duplex sonography, CT- and/or MR-angiography (CT-A, MR-A), or digital subtraction angiography (DSA) [ 1 , 4 , 10 , 11 ]. Treatment options include interventional procedures as well as numerous surgical options [ 1 , 12 ].…”