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[Bilateral blood pressure measurement before and after coronary bypass surgery: an absolute necessity]
J M Ernst1, P F van Bergen, M A Schepens
1Afd. Cardiologie, St. Antonius Ziekenhuis.
Insights
Subclavian artery stenosis can cause anginous symptoms, mimicking cardiac issues. Prompt diagnosis via blood pressure measurement and interventions like balloon angioplasty can effectively treat these conditions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Subclavian artery stenosis can compromise blood flow to the internal thoracic artery graft used in coronary artery bypass grafting (CABG).
- Anginous symptoms may arise from subclavian artery stenosis, potentially misdiagnosed as cardiac ischemia.
- Bilateral blood pressure measurement is a simple diagnostic tool for identifying subclavian artery stenosis.
Observation:
- Four male patients (aged 50-71) presented with anginous symptoms.
- Angiography revealed coronary sclerosis and left subclavian artery stenosis in two patients.
- Two patients with prior arterial CABG developed symptoms due to narrowed subclavian arteries.
Findings:
- Percutaneous dilatation of the subclavian artery resolved symptoms in two patients, one of whom also underwent CABG.
- Balloon dilatation of the subclavian artery and subsequent revascularization or embolization resolved symptoms in two other patients.
- Proximal subclavian artery stenosis or occlusion can reduce blood flow in the ipsilateral internal thoracic artery graft.
Implications:
- Early diagnosis of subclavian artery stenosis through bilateral blood pressure assessment is crucial.
- Interventional treatment of subclavian artery stenosis can alleviate anginous symptoms and protect grafts.
- Understanding the link between subclavian artery disease and graft perfusion is vital for surgical planning and patient management.
Abstract:
Anginous symptoms and a difference in blood pressure between the two arms prompted angiography in two patients, men aged 66 and 50 years. The examination revealed coronary sclerosis and a stenosis in the left subclavian artery. The symptoms disappeared after percutaneous dilatation of the subclavian artery, followed by a coronary bypass operation (CABG) using an internal thoracic artery (a branch of the subclavian artery). In two other patients, men aged 61 and 71 years, who had undergone an arterial CABG 12 years previously, anginous symptoms were the manifestation of a narrowed subclavian artery. The symptoms disappeared after balloon dilatation of the subclavian artery and revascularization of the anterior interventricular branch (left artery descendens) and embolization of the internal thoracic artery graft (internal mammarian artery graft), respectively. Stenosis or occlusion of the proximal subclavian artery may attenuate the blood flow in the ipsilateral A. thoracica interna graft. The diagnosis can simply be made by bilateral blood pressure measurement.