Thorac Cardiovasc Surg 2008; 56(6): 363-365
DOI: 10.1055/s-2008-1038416
Short Communications

© Georg Thieme Verlag KG Stuttgart · New York

Concomitant Coronary Artery Bypass Grafting and Subclavian Revascularization

Y. Beşoğul1
  • 1Department of Cardiovascular Surgery, Osmangazi University Medical School and Research Hospital, Eskişehir, Turkey
Further Information

Publication History

Received December 18, 2007

Publication Date:
14 August 2008 (online)

Introduction

In proximal total subclavian artery occlusion and steal syndrome, the upper extremity circulation steals blood flow from the cerebral circulation by means of collateral circulation, resulting in vertebrobasilar insufficiency. Excessive physical activity of the related arm may result in vertigo or a history of syncope.

The most permanent treatment of subclavian artery (SA) lesions is a bypass grafting technique. Segmental endarterectomy may be performed in rare cases of ulcer and localized atherosclerosis with plaque. In proximal SA occlusion, an intrathoracic approach is preferred for the bypass from the thoracic aorta [1]. Carotid-subclavian bypass and subclavian-carotid transposition techniques are also performed as an alternative [2]. Depending on the atherosclerotic etiology, SA lesions may exist with too many concomitant carotid artery and coronary artery lesions. Coronary artery and carotid surgery is given priority in chronic cases.

Combined CABG and subclavian artery revascularization within the same treatment is rare in the literature [3]. We present a case simultaneously treated with CABG and subclavian artery revascularization.

References

  • 1 Yao J ST. Arterial surgery of the upper extremity. Haimovici H Haimovici's Vascular Surgery. 4th edn. USA; Blackwell Science Inc. 1996: 1092-1109
  • 2 Diethrich E B, Garrett H E, Ameriso J. et al . Occlusive disease of the common carotid and subclavian arteries treated by carotid-subclavian bypass.  Arch Surg. 1967;  114 800-808
  • 3 Kırali K, Mansuroğlu D, Erentuğ V. et al . Subclavian artery – combined revascularization of subclavian artery and coronary artery.  Turkish J Thorac and Cardiovasc Surg. 2000;  777-780
  • 4 Abir F, Kakisis I, Sumpio B. Do vascular surgery patients need a cardiology work-up? A review of pre-operative cardiac clearance guidelines in vascular surgery.  Eur J Vasc Endovasc Surg. 2003;  25 110-117
  • 5 Takach T J, Reul G J, Cooley D A. et al . Concomitant occlusive disease of the coronary arteries and great vessels.  Ann Thorac Surg. 1998;  65 79-84
  • 6 Sterpetti A V, Schultz R D, Farina C. et al . Subclavian artery revascularization: a comparison between carotid-subclavian artery bypass and subclavian-carotid transposition.  Surgery. 1989;  106 624-632
  • 7 Ochi M, Yamauchi S, Yajima T. et al . Simultaneous subclavian artery reconstruction in coronary artery bypass grafting.  Ann Thorac Surg. 1997;  63 1284-1287
  • 8 Öz N, Okur F F, Kılıç A. et al . Surgery of subclavian artery.  Vasc Surgery. 1997;  3 93-97
  • 9 Bozkurt A K, Beşirli K, Tüzün H. et al . Carotico-subclavian and carotico-brachial revascularizations.  Vasc Surgery. 1997;  1 93-97
  • 10 Takach T J, Reul G S, Cooley D A. et al . Myocardial thievery: the coronary-subclavian steal syndrome.  Ann Thorac Surg. 2006;  81 386-392
  • 11 Inoue T, Saya T. Concomitant aortaaxillary bypass grafting.  Asian Cardiovasc Thorac Ann. 2005;  13 229-232
  • 12 Takach T J, Reul G S, Gregoric I. et al . Concomitant subclavian and coronary artery disease.  Ann Thorac Surg. 2001;  71 187-189
  • 13 Sterpetti A V, Schultz R D, Farina C. et al . Subclavian artery revascularization: a comparison between carotid-subclavian artery bypass and subclavian-carotid transposition.  Surgery. 1989;  106 624-632

Dr. MD Yavuz Beşoğul

Department of Cardiovascular Surgery
Osmangazi University

Büyükdere mah. Özgürler sok. 19/5, Ana apt.

26000 Eskişehir

Turkey

Phone: + 90 22 22 29 37 27

Fax: + 90 22 22 29 37 27

Email: ybesogul@gmail.com

Email: ybesogul@hotmail.com