[Subclavian-coronary steal syndrome following CABG--a case report]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
• The left internal mammary artery (LIMA) is frequently used for CABG due to its long-term patency.
• Complications, though rare, can arise post-CABG, necessitating careful patient monitoring.

Observation:

• A 47-year-old male presented with subclavian artery occlusion months after CABG with LIMA grafting.
• The patient experienced vertigo and recurrent chest pain, indicative of subclavian-coronary steal syndrome.
• This syndrome involves retrograde blood flow from the coronary arteries to the subclavian artery via the LIMA.

Findings:

• The LIMA graft, intended to perfuse the coronary arteries, facilitated retrograde flow, causing a steal phenomenon.
• The retrograde flow compromised the brain and cardiac circulation, leading to the patient's symptoms.
• This case underscores a potential, albeit infrequent, complication of LIMA use in CABG.

Implications:

• Subclavian-coronary steal syndrome requires prompt recognition and management.
• Preoperative diagnostic methods, such as measuring pressure gradients between upper limbs, may help identify at-risk patients.
• Further research into preventive strategies and optimal management of this syndrome is warranted.