İnternal Torasik Arter Kullanılmış Koroner Baypaslı ve Aortik Ark Çıkımlı Vertebral Arter Olgusunda Subklavyan Çalma Sendromu: Bir Olgu Sunumu

Abstract

Koroner subklavyan calma sendromu ilk kez 1974 yilinda Harjola ve Valle tarafindan bildirilmistir. Proksimal subklavyan tikayici hastaligindan dolayi vertebral arterdeki tersine akim ve daha once yapilmis LAD’ye (sol anterior desending) - internal torasik arter anastomozu, bu hastalarda koroner ve serebrovaskuler yetmezlige neden olur. 68 yasinda erkek hasta, hafif bas donmesi ve Kanada klas I – II anjina ile hastaneye basvurdu. DSA goruntulemesinde sol subklavyan arter tikanikligi, sol internal karotis arter darligi ve aortik ark cikimli sol vertebral arter saptandi. Koroner – subklavyan calma sendromu nadirdir fakat ITA kullanilmis koroner baypasli hastalarda potansiyel olarak tehlike arz eder. Koroner arter hastaligi ve buyuk damar tikayici hastaligi birlikteligi koroner ve serebral vaskuler yetmezlik kombinasyonunu getirebileceginden, tam klinik ve radyoljik degerlendirme zorunludur. Anahtar kelimeler: Subklavyan calma sendromu, koroner baypas, aortik ark cikimli vertebral arter Subclavian Steal Syndrome in a Coronary Bypass Patient with Vertebral Artery Originating From Aortic Arc and Internal Thorasic Artery Used as a Conduit: A Case Report Coronary subclavian steal syndrome was first reported by Harjola and Valle in 1974. The reversal of flow in the vertebral artery due to proximal subclavian artery occlusive disease and in a previously constructed left internal thoracic artery (ITA) to left anterior descending coronary artery (LAD) caused coronary and cerebrovascular insufficiency in the patient. A 68 year – old man was admitted to the hospital with symptoms of dizziness and Canadian clas I–II angina. He had a history of coronary artery bypass grafting. Physical examination was consistent with subclavian steal syndrome. Digital subtraction angiography (DSA) demonstrated occlusion of the left subclavian artery, left internal carotid artery stenosis and left vertebral artery originated from the aortic arch. The coronary - subclavian steal syndrome tends to be a rare, but potentially hazardous, situation for patients after coronary bypass procedure with ITA grafts. The combination of coronary and cerebrovascular insufficiency is suggestive of concomitant CAD (coronary artery disease) and occlusive disease of the great vessels and mandates a full clinical and radiologic evaluation. Key words: subclavian steal syndrome, coronary artery bypass grafting, left vertebral artery originated from the aortic arch