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Eur J Cardiothorac Surg 2002;22:629
© 2002 Elsevier Science NL

Images in cardio-thoracic surgery

Subclavian steal from in situ left internal thoracic artery bypass

Hans Vanoverbeke*, G. Van Nooten

Department of Cardiac Surgery, University Hospital Gent, Gent, Belgium

Received 26 April 2002; received in revised form 21 May 2002; accepted 4 June 2002.

* Corresponding author. Tel.: +32-9-240-4700
e-mail: hans.vanoverbeke{at}rug.ac.be

Key Words: Subclavian steal • Internal thoracic artery

A 79-year-old man, with a history of coronary artery bypass grafting, presented recurrent stable angina pectoris on exercise, confirmed by scintigraphy. Coronarography showed occluded venous grafts to the right and circumflex coronary arteries, and massive retrograde flow through a patent left internal thoracic artery (LITA) in situ graft to the left anterior descending artery, perfusing the subclavian artery. The proximal left subclavian artery was occluded, resulting in a subclavian steal phenomenon (Figs. 1 and 2) . Carotid subclavian bypass was proposed, but the patient refused surgery and is being medically treated.



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  		Fig. 1. Subclavian steal.

 


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  		Fig. 2. Retrograde LITA flow.

 




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