Isolated proximal subclavian artery (SA) stenosis is primarily treated by PTCA. It can be either symptomatic (vertebrobasillar insufficiency or ischemia of upper extremity) or asymptomatic. It is rarely associated with coronary artery disease.

Methods:

Between 1985 and 2000, three patients were treated simultaneously by aorto-subclavian bypass and CABG. All patients were male, and 47, 52, and 61 years old, respectively. In two patients there was total occlusion of the left SA. The third patient had a severe stenosis at the proximal segment of the right SA. The surgical procedures were CABG on the beating heart (LIMA-LAD) and aorto-right subclavian bypass, CABG (RIMA-LAD, RGEA-RCA, Ao-CxOM3) and aorto-left subclavian bypass, and CABG (3 vessels, only saphenous vein) and aorto-left subclavian bypass. Saphenous vein was used as the graft for subclavian bypass.

Results:

There was no early or late mortality. Control investigations showed the patency of all grafts. There was no upper extremity or cardiac ischemia in the follow-up period.

Conclusions:

Use of IMA for CABG is the gold standart. Simultaneous coronary artery disease can effect graft choice and surgical approach in SA bypass surgery. Preoperative angiographic evaluation of SA must be performed in all patients regardless of the presence of symptoms of SA stenosis.