Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Subclavian artery stenosis (SAS) affects 6% of patients undergoing coronary artery bypass grafting (CABG).
• Subclavian-coronary steal is a common complication, making revascularization strategies debatable.
• Accurate preoperative assessment is crucial for managing SAS in CABG candidates.

Purpose of the Study:

• To evaluate the safety and efficacy of a RIMA-LIMA-Y graft configuration in CABG patients with left SAS.
• To highlight the role of CT angiography in diagnosing SAS preoperatively.
• To present a case series demonstrating successful revascularization in complex cases.

Main Methods:

• A case series of patients with angina and severe triple-vessel disease undergoing CABG.
• Preoperative workup included computed tomography (CT) angiography of neck vessels to assess SAS.
• Total arterial revascularization using a RIMA-LIMA-Y configuration was performed.

Main Results:

• Patients were male, with a mean age of 66.5 years, hypertension, diabetes, and ex-smoker history.
• CT angiography revealed moderate to severe left SAS in two patients and severe proximal left internal mammary artery (LIMA) stenosis in one.
• All patients underwent successful RIMA-LIMA-Y grafting with an average of 3.5 distal grafts, experiencing uneventful recovery and remaining asymptomatic at 6-month follow-up.

Conclusions:

• The RIMA-LIMA-Y configuration is a safe and viable option for CABG in patients with left SAS.
• Judicious utilization of LIMA length and successful re-entry are critical technical considerations.
• CT angiography of neck vessels is essential for detecting SAS and planning surgical approach.