Acute coronary syndrome following arteriovenous fistula creation in a post CABG patient: A steal phenomenon from coronary artery to subclavian artery.

Seminars in Dialysis
Mohammad Javad Alemzadeh-AnsariBahram Mohebbi

Abstract

A 70-year-old man with a history of coronary artery bypass grafting 15 years back and arteriovenous (AV) fistula creation in the left arm 1 month back presented with acute coronary syndrome (ACS). He had not received dialysis before his referral. We felt the most likely etiology for these complaints was increased cardiac oxygen demand from an increased cardiac output related to the newly formed left AV fistula. Coronary angiography was done to detect any significant stenosis in the native or grafted vessels. This revealed that the left subclavian artery was totally occluded in the ostioproximal segment and the coronary arteries did not have occlusions to explain the ACS setting. CT angiography confirmed the angiographic findings of the totally occluded left subclavian artery followed by a well-developed and patent left internal mammary artery to left anterior descending artery. This led to the consideration of a steal syndrome from the coronary artery by the subclavian artery distal to the occlusion. A successful percutaneous endovascular intervention on the left subclavian artery occlusion was performed. Subsequently, the patient became asymptomatic and experienced a dramatic increase in left ventricular ejection fraction.

References

May 25, 2010·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·J VeceraJ Kvasnicka
Nov 17, 2010·Vascular Medicine·Victor M Ochoa, Yerem Yeghiazarians
Jun 4, 2014·Circulation·Brian J Potter, Duane S Pinto
Jan 23, 2017·The American Journal of Medicine·Tisa SahaSheldon Goldberg
Apr 19, 2017·Journal of cardiology·Bennett CuaCarlos Mena-Hurtado

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