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Eur J Cardiothorac Surg 2009;35:740-742. doi:10.1016/j.ejcts.2009.01.008
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Case reports

Recurrent pulmonary edema induced by coronary-subclavian steal syndrome during hemodialysis

Sudip Nandaa,*, Santo Longob, John Pamulaa, Thompson H. Dalec

a Department of Internal Medicine, St. Luke's Hospital, 801, Ostrum Street, Bethlehem, PA 18015, United States
b Department of Pathology, St. Luke's Hospital, 801, Ostrum Street, Bethlehem, PA 18015, United States
c Department of Cardiology, St. Luke's Hospital, 801, Ostrum Street, Bethlehem, PA 18015, United States

Received 10 November 2008; received in revised form 6 January 2009; accepted 7 January 2009.

* Corresponding author. Tel.: +1 610 954 4644; fax: +1 610 954 4920. (Email: sudipnanda2000{at}yahoo.com; LongoS{at}slhn.org; PamulaJ{at}slhn.org; DaleT{at}slhn.org).

We describe a case of recurrent pulmonary edema after hemodialysis despite the patient being at ideal dry weight. Coronary-subclavian steal syndrome can cause serious complications in end-stage renal disease patients on hemodialysis. This is a case of subclavian steal, made worse by hemodialysis, using an upper limb hemodialysis fistula. Complete resolution of symptoms followed percutaneous stenting of the arteriosclerotic subclavian artery. A high index of suspicion of this physiological phenomenon is needed for diagnosis.

Abbreviations: CAD = coronary artery disease • CABG = coronary artery bypass grafting/surgery • LAD = left anterior descending artery • IMA = internal mammary artery • SAS = subclavian artery stenosis • CSS = coronary-subclavian steal

Key Words: Coronary-subclavian steal syndrome • Proximal subclavian artery stenosis • Recurrent pulmonary edema






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Copyright © 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.