ABSTRACT
This 55-year-old man was admitted for revascularization of an occluded left subclavian artery. He underwent coronary artery bypass graft (CABG) in January 2000, with a left internal mammary artery (LIMA) to the left anterior descending artery (LAD), saphenous vein graft (SVG) to the OM, and SVG to the right coronary artery (RCA). He developed recurrent angina 14 months after CABG and repeat angiography demonstrated total occlusion of the SVG to the OM, and high-grade stenosis of the proximal left subclavian artery. The stenotic proximal left subclavian artery was dissected and occluded during attempts to perform angiography. He underwent percutaneous transluminal coronary angioplasty (PTCA) stenting of the left circumflex artery but still had persistent angina, dyspnea, left arm claudication and vertebrobasilar insufficiency. A duplex ultrasound examination revealed a 40 mmHg pressure gradient between the left and right arm, reversed flow in the left vertebral artery consistent with subclavian and coronary artery steal, and normal carotid arteries bilaterally.
