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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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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
PubMed

Insights

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.
Abstract

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