Tönz M, von Segesser L, Carrel T, Pasic M, Turina M
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
Thorac Cardiovasc Surg. 1993 Apr;41(2):112-7. doi: 10.1055/s-2007-1013833.
Stenosis of proximal subclavian artery (SCA), malformations of the internal mammary artery (IMA) at its origin, or large IMA side branches may cause myocardial ischemia due to blood-steal through a patent IMA graft. Thirty-one cases of postoperative steal syndromes have been reported in the literature, 23 due to proximal SCA stenosis, seven due to large IMA side branches and one due to an IMA malformation. We report two additional cases and discuss them in conjunction with the cases in the literature. Thirty patients suffered from recurrent angina pectoris, three had asymptomatic reversal of flow in the IMA as diagnosed by coronary angiography during routine follow-up examination. Carotid-subclavian bypass grafting is the treatment of choice for the management of proximal SCA stenosis. IMA malformations or large side branches are treated by interruption of the responsible vessel, either by ligation or by transarterial catheter embolization. In 82% (27 of 33), steal syndrome could have been prevented by preoperative angiography of the IMA. We advocate it as a routine procedure in combination with coronary arteriography.
近端锁骨下动脉（SCA）狭窄、胸廓内动脉（IMA）起始部畸形或IMA大的分支，可能会因通过通畅的IMA移植物发生“窃血”而导致心肌缺血。文献报道了31例术后窃血综合征病例，其中23例因近端SCA狭窄，7例因IMA大的分支，1例因IMA畸形。我们报告另外2例，并结合文献中的病例进行讨论。30例患者出现复发性心绞痛，3例在常规随访检查中经冠状动脉造影诊断为IMA血流逆向但无症状。颈动脉-锁骨下动脉旁路移植术是治疗近端SCA狭窄的首选方法。IMA畸形或大的分支通过结扎或经动脉导管栓塞等方法阻断相关血管进行治疗。在82%（33例中的27例）的病例中，术前对IMA进行血管造影本可预防窃血综合征。我们主张将其作为与冠状动脉造影相结合的常规检查。
