151. Percutaneous subclavian artery bypass for myocardial perfusion during endovascular intervention
- Author
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Sridevi R. Pitta, Abhiram Prasad, Gregory W. Barsness, Rajiv Gulati, and Verghese Mathew
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Vertebral artery ,Myocardial Ischemia ,Myocardial Reperfusion ,Blood Transfusion, Autologous ,Subclavian Steal Syndrome ,Internal medicine ,Angioplasty ,medicine.artery ,Ascending aorta ,Myocardial Revascularization ,Medicine ,Humans ,cardiovascular diseases ,Mammary Arteries ,Subclavian artery ,Aged ,Aorta ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Bypass surgery ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
A 75-year-old woman with familial hypercholesterolemia was admitted with unstable angina. Thirteen years earlier, she had undergone coronary artery bypass grafting with a left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and subsequently bilateral common carotid bypass surgery through a second sternotomy 3 years later. Physical examination revealed left brachial hypotension, a left subclavian bruit, and features of severe aortic stenosis. Transthoracic echocardiography demonstrated severe valvular and supravalvular aortic obstruction with an area of 0.50 cm2. Noncontrast computed tomography showed complete calcification of the ascending aorta (porcelain aorta) and confirmed supravalvular obstruction with calcific plaque (Figure 1). She was subsequently offered placement of a left ventricular apex-descending aorta conduit through a left thoracotomy. Preoperative diagnostic angiography revealed a critical ostial left subclavian artery stenosis, with flow reversal in the vertebral artery and preferential entering of contrast into the LIMA (steal phenomenon, Figure 2, Movie 1). The LIMA graft was widely …
- Published
- 2009