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Concomitant subclavian and coronary artery disease
T J Takach1, G J Reul, I Gregoric
1Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345, USA.
The Annals of Thoracic Surgery
|February 24, 2001
Summary
Subclavian artery revascularization effectively treats coronary-subclavian steal syndrome, a complication of coronary artery bypass grafting. This intervention offers protection and treatment with low operative risk and good midterm patency.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
Background:
- Proximal subclavian artery occlusive disease can lead to coronary-subclavian steal syndrome when the internal mammary artery is used for coronary artery bypass grafting.
- This condition can cause myocardial ischemia due to reversed flow in the internal mammary artery.
Purpose of the Study:
- To evaluate the effectiveness of subclavian artery revascularization in protecting against and treating coronary-subclavian steal syndrome.
- To assess the outcomes and patency rates of different revascularization methods.
Main Methods:
- A review of 20 patients between 1985 and 1997 with either concomitant subclavian and coronary artery disease or symptomatic coronary-subclavian steal.
- Group 1 (5 patients) underwent direct subclavian artery bypass and simultaneous coronary artery bypass grafting.
- Group 2 (15 patients) were treated with subclavian-carotid bypass or percutaneous transluminal angioplasty and stenting.
Main Results:
- All patients achieved symptom relief post-intervention.
- Primary patency was 100% in Group 1 (mean follow-up 3.7 years).
- Secondary patency was 100% in Group 2 (mean follow-up 2.9 years) after one late recurrence was revised.
Conclusions:
- Subclavian artery revascularization is an effective treatment for coronary-subclavian steal syndrome.
- The procedure offers protection with acceptably low operative risk and demonstrates good midterm patency.