[Results of percutaneous dilatation of subclavian artery stenosis in patients with internal mammary grafts]

Abstract

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for subclavian artery (SCA) stenosis before or after coronary artery bypass grafting (CABG) with the internal mammary artery (IMA). There were 8 men and 3 women with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of asymptomatic subclavian murmurs or of neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was present on the left side in 9 patients, the right side in one patient, and was bilateral in one patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. Three complications occurred: 1 femoral artery thrombosis, 1 branchial plexus hematoma after an axillary approach, and 1 acute pulmonary edema after the procedure. Follow-up ranged from 1 to 60 months after PTA (mean 38 +/- 17 months). Nine patients had no angina at follow-up and 2 presented with stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in all of these patients, at a mean follow-up of 38 months. Subclavian artery percutaneous transluminal angioplasty is a useful alternative for candidates to IMA bypass grafting with SCA stenosis discovered pre-operatively, and it is the treatment of choice for those presenting with post-CABG angina due to SCA stenosis proximal to an IMA graft.