Letter to the Editor © 1991 S. Karger AG, Basel 0008-6312/91/0793-0244J2.75/0
Cardiology 1991 ;79:244
Dear Sir, I read with interest the article on the cor onary-subclavian steal syndrome following coronary bypass by Saydjari et al. [ 1]. In every patient studied for coronary artery dis ease, I routinely inject both subclavian arter ies for three reasons. First, it is a simple procedure to perform toward the end of catheterization before the preformed right coronary artery catheter is withdrawn transfemorally. As the latter comes around the aortic arch, it often pops automatically into either the innominate ar tery, from which the right subclavian artery arises, or the left subclavian artery. Second, routine pre-bypass subclavian angiography will not only detect subclavian stenosis, but also internal mammary artery disease. As much as 2% of internal mam mary arteries are unsuitable as coronary by pass grafts because of the presence of signifi cant atherosclerosis in either those arteries or the subclavian arteries [2], Third, subclavian stenosis may not al ways manifest clinically as a difference in blood pressure between the two arms. Three
of 12 cases in the article by Saydjari et al. [ 1] had an upper extremity systolic blood pres sure gradient of less than 20 mm Hg, which was the indication for subclavian arterio grams as proposed by the authors.
References 1 Saydjari R, Upp JR. Wolma FJ: Coronary-sub clavian steal syndrome following coronary artery bypass grafting. Cardiology 1991:78:53-57. 2 Bashour TT. Crew .1. Kabbani SS. Fllertson D. Hanna ES, Cheng TO: Symptomatic coronary and cerebral steal after internal mammary-coronary bypass. Am Heart J 1984:108:177-178.
Tsung O. Cheng. MD Professor of Medicine George Washington University Washington. DC 20037 (USA)
Cardiology 1991 ;79:244
Dear Sir, I read with interest the article on the cor onary-subclavian steal syndrome following coronary bypass by Saydjari et al. [ 1]. In every patient studied for coronary artery dis ease, I routinely inject both subclavian arter ies for three reasons. First, it is a simple procedure to perform toward the end of catheterization before the preformed right coronary artery catheter is withdrawn transfemorally. As the latter comes around the aortic arch, it often pops automatically into either the innominate ar tery, from which the right subclavian artery arises, or the left subclavian artery. Second, routine pre-bypass subclavian angiography will not only detect subclavian stenosis, but also internal mammary artery disease. As much as 2% of internal mam mary arteries are unsuitable as coronary by pass grafts because of the presence of signifi cant atherosclerosis in either those arteries or the subclavian arteries [2], Third, subclavian stenosis may not al ways manifest clinically as a difference in blood pressure between the two arms. Three
of 12 cases in the article by Saydjari et al. [ 1] had an upper extremity systolic blood pres sure gradient of less than 20 mm Hg, which was the indication for subclavian arterio grams as proposed by the authors.
References 1 Saydjari R, Upp JR. Wolma FJ: Coronary-sub clavian steal syndrome following coronary artery bypass grafting. Cardiology 1991:78:53-57. 2 Bashour TT. Crew .1. Kabbani SS. Fllertson D. Hanna ES, Cheng TO: Symptomatic coronary and cerebral steal after internal mammary-coronary bypass. Am Heart J 1984:108:177-178.
Tsung O. Cheng. MD Professor of Medicine George Washington University Washington. DC 20037 (USA)
