RESULTS OF PERCUTANEOUS DILATATION OF SUB CLAVIAN ARTERY STENOSES IN PATIENTS WITH INTERNAL MAMMARY ARTERY BYPASS GRAFTS

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for subclavian artery (SCA) stenosis be fore 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 o f neurologic symptoms. Seven patients underwent PTA 2 to 37 months aft er CABG with IMA grafts, because of recurrent angina. Subclavian arter y 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 w ere successful in 9 patients. All patients with post-CABG angina had r eversal of the ischemia. Three complications occurred: 1 femoral arter y 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 n o angina at follow-up and 2 presented with stable angina (class II) up on exertion. Upper-limb Doppler studies showed no evidence of restenos is in all of these patients, at a mean follow-up of 38 months. Subclav ian artery percutaneous transluminal angioplasty is a useful alternati ve for candidates to IMA bypass grafting with SCA stenosis discovered pre-operatively, and it is the treatment of choice for those presentin g with post-CABG angina due to SCA stenosis proximal to an IMA graft.