Department of Cardiothoracic and Vascular Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata.
Asian Cardiovasc Thorac Ann. 2024 Sep;32(6-7):395-399. doi: 10.1177/02184923241284318. Epub 2024 Nov 3.
Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.
In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.
The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.
The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.
锁骨下动脉狭窄（SAS）在接受冠状动脉旁路移植术（CABG）的患者中发生率为 6%。常见并发症包括锁骨下-冠状动脉窃血。此类情况下的血运重建选择仍存在争议。
在本病例系列中，所有心绞痛患者均在血管造影时存在严重的三支血管病变。所有检查包括颈部血管 CT 血管造影术，均作为 CABG 常规检查的一部分进行。
所有患者均为男性，平均年龄为 66.5 岁，其中 3 例患有高血压和糖尿病。所有患者均为戒烟者，平均射血分数（EF）为 60.1%。颈部血管 CT 血管造影显示，2 例患者存在中重度，1 例患者存在严重左侧 SAS，另 1 例患者存在严重左侧乳内动脉（LIMA）近端狭窄。行全动脉血运重建，平均使用 3.5 个远端移植物。LIMA 移植物采用 Y 型吻合方式，吻合到原位右侧乳内动脉（RIMA）。所有患者术后均恢复顺利，平均住院 3.8 天。无术后卒中和心肌梗死、神经系统症状或 EF 改变。6 个月随访时，患者无症状，恢复良好。
对于存在左侧 SAS 的 CABG 患者，RIMA-LIMA-Y 构型是一种安全可行的选择。这是一项具有挑战性的手术，再进入和明智利用 LIMA 的长度至关重要。强调颈部血管 CT 血管造影术对检测 SAS 的重要性不容忽视。
