Angina pectoris caused by subclavian coronary steal

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for ischemic heart disease.
• Internal mammary artery grafts are frequently used due to their durability.
• Complications, though rare, can occur post-CABG, necessitating further investigation and intervention.

Observation:

• A 79-year-old female patient presented with recurrent chest pain four months after undergoing CABG with a left internal mammary artery graft.
• Diagnostic imaging revealed a complete occlusion of the left subclavian artery.
• A coronary subclavian steal syndrome was identified, indicating reversed blood flow from the coronary arteries to the subclavian artery.

Findings:

• The patient's symptoms were directly attributed to the coronary subclavian steal, a consequence of the left subclavian artery occlusion.
• The pathophysiology involves retrograde flow from the vertebral or internal mammary artery into the occluded subclavian artery, compromising myocardial perfusion.
• Successful treatment was achieved using an axillo-axillary Gore-Tex graft, bypassing the occluded segment.

Implications:

• This case highlights the importance of considering graft-related complications and vascular steal syndromes in patients with post-CABG chest pain.
• Axillo-axillary bypass grafting is a viable therapeutic option for managing coronary subclavian steal syndrome.
• Understanding the pathophysiology of coronary subclavian steal is crucial for timely diagnosis and effective management in surgical patients.