Coronary ischemia due to subclavian stenosis after arterial revascularization

We describe a case of coronary-subclavian steal in a 60-year-old man who presented with progressive ischemia 16 years after coronary artery bypass with in-situ bilateral internal thoracic artery grafts. Angiography revealed completely patent arterial grafts, but subtotal stenosis of the left subclavian artery. On reoperation, a vein graft was used to connect the aorta to the left internal thoracic artery which was proximally disrupted. No coronary ischemia was found postoperatively.