Screening for left subclavian artery stenosis in patients undergoing coronary artery bypass graft surgery

Abstract

Aim. Stenosis of the left subclavian artery may decrease the clinical benefit of the surgery and result in the coronarysubclavian steal syndrome. This study sought to evaluate the frequency of the subclavian artery stenosis via color Doppler ultrasonography (CDU) and determine the risk factors for subclavian artery stenosis. Methods. Three hundred and twenty consecutive patients who were referred for coronary artery bypass graft surgery were included in the study. All patients underwent subclavian artery color Doppler ultrasonographic evaluation while routine carotid artery examination was performed during the preoperative period. Patient characteristics including demographic, echocardiographic, operative, clinical and laboratory parameters were recorded. Results. Twenty-three of the 320 patients (7.18%) had stenosis of the left subclavian artery while 7 patients (2.18%) also had right subclavian artery stenosis. Age, dyslipidemia, chronic renal failure, peripheral artery disease (PAD), proximal right coronary artery (RCA) stenosis and carotid artery stenosis were all significantly associated with subclavian stenosis. In multivariate regression modeling; age, PAD, proximal RCA stenosis and carotid artery stenosis independently predicted subclavian stenosis. Conclusion. We recommend routine preoperative screening with CDU for those coronary artery bypass grafts patients at high risk for subclavian artery stenosis.