Korean Circ J.  2012 Nov;42(11):784-787. 10.4070/kcj.2012.42.11.784.

Recurrence of Coronary-Subclavian Steal Syndrome After Successful Angioplasty of Malfunctioning Arteriovenous Fistula

• Han HJ
• Kang BS
• Cho YH

• KMID: 2224981
• DOI: http://doi.org/10.4070/kcj.2012.42.11.784

Abstract

We report a case of coronary-subclavian steal syndrome, which had been masked by a malfunctioning hemodialysis access vessel and then reappeared after a successful angioplasty of multiple stenoses in the arteriovenous fistula of the left arm in a 61-year-old man. This case suggests that coronary-subclavian steal syndrome should be considered before a coronary artery bypass grafting surgery using internal mammary artery conduit is done, especially when hemodialysis using the left arm vessels is expected.

Keyword

Coronary-subclavian steal syndrome; Coronary artery bypass; Arteriovenous fistula

MeSH Terms

Angioplasty
Arm
Arteriovenous Fistula
Constriction, Pathologic
Coronary Artery Bypass
Coronary-Subclavian Steal Syndrome
Glycosaminoglycans
Humans
Mammary Arteries
Masks
Middle Aged
Recurrence
Renal Dialysis
Glycosaminoglycans

Figure

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  Fig. 1 Coronary angiography and left subclavian artery angioplasty 1 year prior to clinic admission. A: left coronary angiography demonstrating 'to-and-fro' flow reversal in the left internal mammary artery, suggesting coronary-subclavian steal syndrome. B: selective left internal mammary arteriography showed no significant stenosis of the left internal mammary artery graft itself while its anastomoses to native coronary arteries was demonstrated. C and D: selective left subclavian arteriography revealed a significant stenosis (80%) of the left subclavian artery (arrow) (C), which was resolved after balloon angioplasty with stenting of the left subclavian artery (D).

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  Fig. 2 Arteriovenous fistulogram of left arm 1 week prior to clinic admission. Multiple stenoses of the venous outflow tract (A and B), which resolved after successful balloon angioplasty (C and D), were observed.

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  Fig. 3 Coronary angiography and left subclavian artery angioplasty on admission. A: left coronary angiography showed 'to-and-fro' flow reversal in the left internal mammary artery, suggesting coronary-subclavian steal syndrome. B: selective left internal mammary arteriography demonstrated that no significant stenosis of the left internal mammary artery graft itself was present and its anastomoses to native coronary arteries was shown. C and D: selective left subclavian arteriography showed a significant instent restenosis (80%) of the left subclavian artery (arrow) (C), which was resolved after balloon angioplasty with peripheral cutting balloon of the left subclavian artery (D).

Reference

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