ANGINA CAUSED BY CORONARY-SUBCLAVIAN STEAL IN PATIENTS WITH CORONARY-ARTERY BYPASS WITH INTERNAL MAMMARY ARTERY

After coronary bypass surgery in the left internal mammary artery, occ lusive atheroesclerosis in the proximal subclavian artery can produce reverse flow in the mammary artery and myocardial ischemia (coronary-s ubclavian steal syndrome). This is a rare cause of recurrent myocardia l ischemia. We present two patients with postoperative complete obstru ction in the proximal subclavian artery and inverse flow in the mammar y artery producing severe ischemia in the left anterior descending art ery territory. Both patients were treated with subclavian-subclavian b ypass, which in one patient was ineffective in producing an adequate a nterograde flow in the left internal mammary artery. We review clinica l management, diagnostic methods and therapeutic options used in the c oronary-subclavian steal syndrome.