TRANSLUMINAL ANGIOPLASTY OF THE SUBCLAVIAN ARTERY IN PATIENTS WITH INTERNAL MAMMARY GRAFTS

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for the treatment of subclavian artery stenosis before or after coronary artery bypass grafting (CABG) using 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 befo re undergoing CABG with IMA grafts, because of either asymptomatic sup raclavicular murmurs or neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent an gina. Subclavian artery stenosis was on the left side in 9 patients, t he right side in 1 patient, and bilateral in 1 patient. Ten PTA proced ures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. There were three complications: one fem oral artery thrombosis, one brachial plexus hematoma after an axillary approach, and one acute pulmonary edema after the procedure. Follow-u p after PTA ranged from 1 to 60 months (mean, 38 +/- 17 months). Nine patients had no angina at follow-up and 2 had stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of reste nosis in any of these patients at a mean follow-up of 38 months. Subcl avian artery PTA is a useful alternative to IMA bypass grafting in pat ients with subclavian artery stenosis discovered preoperatively, and i t is the treatment of choice for those presenting with post-CABG angin a due to subclavian artery stenosis proximal to an IMA graft.