The coronary-subclavian-vertebral steal syndrome (CSVSS)
F Marquardt1, D Hammel, H J Engel
1Abteilung für Thorax-Herz-Gefässchirurgie, Klinikum "Links der Weser" Bremen, Senator Wesslingstrasse 1, 28277 Bremen, Germany. frank.marquardt@klinikum-bremen-ldw.de
Summary
Reverse flow in the internal thoracic artery (ITA) after coronary bypass surgery, known as coronary-subclavian steal syndrome (CSSS), can cause angina. Surgical or endovascular treatment effectively restores antegrade flow, relieving symptoms.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts is standard practice.
- Subclavian artery occlusion can lead to retrograde flow in the ITA, causing steal syndromes.
- Coronary-subclavian steal syndrome (CSSS) and coronary-subclavian-vertebral steal syndrome (CSVSS) present with angina and/or cerebral symptoms.
Observation:
- Four patients presented with recurrent angina and/or cerebral symptoms years after CABG with ITA grafts.
- Symptoms were attributed to subclavian artery occlusion causing retrograde flow in the ITA grafts.
- Two patients also experienced vertebral steal symptoms, including dizziness and drop attacks.
Findings:
- Surgical revascularization (carotid-subclavian bypass or endarterectomy with patchplasty) or endovascular treatment (angioplasty and stenting) successfully restored antegrade flow in the ITA grafts.
- All treated patients experienced immediate relief from angina and cerebral symptoms.
- Long-term follow-up showed sustained symptom relief and restored antegrade flow in most patients.
Implications:
- CSSS and CSVSS are rare but significant complications after CABG with ITA grafts.
- Prompt diagnosis and treatment are crucial for symptom resolution and preventing further complications.
- Extrathoracic bypass or endovascular interventions offer effective solutions for subclavian artery occlusions not amenable to other treatments.
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