Subclavian artery angioplasty proximal to a left internal mammary-coronary artery bypass graft: case report.

Subclavian artery angioplasty is an established treatment for subclavian steal syndrome and arm ischemia caused by subclavian stenosis. We report a case of angina pectoris caused by a subclavian artery stenosis proximal to a left internal mammary-coronary artery bypass graft. Angioplasty was performed without complication and with complete relief of symptoms. Reactive hyperemia was induced in the forearm and hand with a blood pressure cuff prior to angioplasty to increase blood flow to the arm, and to reduce the chance of graft embolization. Repeat angiography 6 months later confirmed continued patency of the subclavian artery and the graft and reversal of the steal physiology. The patient remains symptom free 15 months after angioplasty.