Authors: Victor Ginzburg; Giora Margulis; George Greenberg; Olga Mayzler; Talya Wolak; Moshe Zlotnik; Elizabeth Avrahami; Jonatan Bat-Sheva; Gabriel Szendro

Source: Journal for Vascular Ultrasound, Volume 28, Number 4, December 2004 , pp. 229-231(3)

Publisher: Society for Vascular Ultrasound

Abstract:

In patients undergoing chronic hemodialysis through an arteriovenous fistula (AVF), coronary insufficiency may occur if the patient undergoes coronary artery bypass grafting (CABG) using the ipsilateral internal mammary artery (left internal mammary artery [LIMA] or right internal mammary artery [RIMA]). Creation of a new AVF after CABG should therefore avoid using the arm ipsilateral to the side where the internal mammary artery was used. In cases where coronary syndrome appears when this advice was not followed, treatment should be offered aiming to overcome the hemodynamic interference between the diminished coronary supply through the LIMA/RIMA and the excessive flow through the AVF. By using subclavian artery (SCA) waveform analysis on a duplex scan, a noninvasive evaluation of the flow through the SCA ipsilateral to the side of the mammary artery and the fistula can be performed both with the patent (functioning) and closed fistula. Waveform analysis can enlighten the phenomena of steal syndrome through the internal mammary artery and is highly recommended in this small and unusual group of patients.

Document Type: Case report

Publication date: 2004-12-01

More about this publication?

• The Journal for Vascular Ultrasound (JVU) is the official journal of the Society for Vascular Ultrasound. It consists of original scientific and educational articles, case studies, book reviews, technical reviews, ultrasound principle reviews, viewpoints, letters to the editor, and CME tests. Regular reading of JVU, published quarterly, will keep you current in your field and provide essential information that can be applied in your practice.
  
  Previously known as the Journal of Vascular Technology - View Volumes 16-26 here
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