Myocardial ischemia in a patient with peripheral vascular disease, an arteriovenous fistula, and patent coronary artery bypass grafts

Patients with coronary artery disease often have concurrent peripheral vascular disease. The presence of concurrent vascular pathologies can pose unique challenges among patients who have undergone coronary artery bypass grafting utilizing the left internal mammary artery. We describe a patient with peripheral vascular disease and prior history of coronary artery bypass grafting, who presented with recurrent anginal symptoms and an abnormal stress test despite the absence of significant residual unrevascularized coronary artery disease. Additional evaluation led to the identification of an ipsilateral severe subclavian stenosis with a concomitant ipsilateral upper extremity arteriovenous fistula. Patient's symptoms resolved with the treatment of the underlying vascular lesions.

Myocardial ischemia in a patient with peripheral vascular disease, an arteriovenous fistula, and patent coronary artery bypass grafts Article (Faculty180)