The Place of Carotico-Subclavian Bypass Surgery in Angina Treatment
A 54-year-old male was admitted to our hospital with complaints of severe dyspnea, inability to lie in supine position, decrease in effort capacity, and pain in the left arm. Physical examination revealed tachycardia and 3/6 apical systolic murmur; bilateral rales in lower lung zones. Brachial, axillary, and radial pulses of the left arm were not palpable but were clearly palpated over the right arm. Lower extremity pulses were palpable. Past medical history revealed that he underwent coronary bypass graft operation five years prior to presentation.\nHe was assessed to have New York Heart Association Functional Classification Class III-IV, with a clinical diagnosis of ischemic cardiomyopathy (CMP), decompensated heart failure. An echoacradiogram was performed which showed increased left ventricular diameter and left ventricular ejection fraction of 18% by the modified Simpson method. He was started on diuretic and vasodilator treatment with regression of failure symptoms. However, he continued to have symptoms of angina and left arm pain responsive to isosorbide dinitrate. A differential diagnosis of CSSS was considered and patient underwent coronary angiography. It was observed on coronary angiography that point of origin of the left subclavian artery in the aorta was totally congested beginning from approximately 1 cm proximal []. A vertebral artery angiography was showed subclavian in bridge collaterals and flow to LIMA were observed in late period.\nUsing a ringed polytetrafluoroethylene (PTFE) graft (Vascutek, Germany) with a diameter of 6 mm, a left carotid-subclavian bypass was performed on the patient in elective conditions. Carotid shunt was not used while systemic heparin (5000 units) was administered during the operation. Postoperatively, a good graft pulse was felt in addition to easily palpable left upper extremity pulses. There were no complications. Following the operation and in the postoperative period, the complaints of the patient related to chest pain, dyspnea, and left arm pain progressively decreased. The patient was discharged on the postoperative day 5. Control coronary-subclavian angiogram 1 month later revealed an intact PTFE graft between carotid and subclavian artery [].