To the Editor,We would like to thank the authors for their constructive comments to our article entitled “Coronary-subclavian steal syndrome in a hemodialysis patient with ipsilateral subclavian artery occlusion and contralateral vertebral artery stenosis “Case Report”“ published in Anatol J Cardiol 2016; 16: 545-6 (1).The use of left internal thoracic artery (ITA) grafts has clinical advantages in ESRDpatients with respect to assuring a higher patency rate and avoiding the need to perform proximal aortic anastomosis. The prevalence of significant left subclavian artery and/or ITA stenosis in patients referred for coronary bypass surgery is reported to be 0.2%–6.8% (2). The prevalence in end-stage renal failure (ESRF) and hemodialysis patients appears to be higher because peripheral artery diseases coexist more frequently (3). Therefore, we strongly recommend preoperative evaluation of ITA and the subclavian artery in ESRF patients undergoing coronary artery bypass surgery. When ipsilateral subclavian artery stenosis is seen, stenting of the proximal subclavian artery stenosis may be performed in order to use ipsilateral ITA for grafting. Alternatively, contralateral ITA or free ITA grafts must be utilized. Finally, when possible, the placement an arteriovenous hemodialysis fistula in a patient with a functioning ITA graft would be better performed on the contralateral upper extremity.