Prevalence of subclavian artery stenosis in patients with peripheral vascular disease

Internal mammary arteries (IMA) as conduits in coronary artery bypass graft ing are superior to saphenous vein grafts. If there is subclavian artery st enosis (SAS) proximal to the IMA graft, impairment of flow to the IMA may o ccur. If the stenosis is severe, retrograde flow from the grafted coronary artery to the brachial artery may lead to angina. Following the identificat ion of 2 cases of angina secondary to subclavian artery stenosis at their i nstitution, the authors prospectively performed arch angiography in a cohor t of patients with manifestations of peripheral vascular disease undergoing diagnostic coronary angiography to assess the prevalence of subclavian ste nosis. Fifty-two patients were enrolled in the protocol, with 48 patients h aving technically acceptable studies. Of these 48, 41.6% had measurable ste nosis of at least one of the brachiocephalic arteries, with 35% of patients with at least a 30% stenosis of the left subclavian artery and 18.7% with more than 50% stenosis. They conclude that patients with significant peripheral vascular disease un dergoing coronary angiography who are potential candidates for revasculariz ation may benefit from arch angiography as part of their initial evaluation .