Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery

Osborn, Larry A.; Vernon, Sarah M.; Reynolds, Bryan; Timm, T. Craig; Allen, Kathleen

doi:10.1002/ccd.10198

Cited by 86 publications

(61 citation statements)

References 8 publications

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“…However, the variability resulting from these interactions is considered trivial compared with the greater ABI variability between different subjects. The variability of ankle pressures was found to be similar to that of arm pressures in 3 reports, 2,181,189 whereas in 5 other studies, 157,166,167,196,201 a better reproducibility of the arm pressures was reported. Overall, data demonstrate that the ABI is a valid biological parameter.…”

Section: Overall Reliability and Reproducibility Of Abi Measurementsupporting

confidence: 52%

“…Differences in SBP between arms may occur in the case of subclavian artery stenosis. Osborn et al 201 reported 100% sensitivity and specificity to detect Ͼ50% subclavian stenosis when the interarm blood pressure difference exceeded 15 mm Hg. Thus, subclavian artery stenosis should be suspected when the SBP difference between both arms is Ն15 mm Hg.…”

Section: Standard Calculation Of the Abimentioning

confidence: 99%

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Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,340

872

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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Section: Overall Reliability and Reproducibility Of Abi Measurementsupporting

confidence: 52%

Section: Standard Calculation Of the Abimentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,340

872

View full text Add to dashboard Cite

show abstract

“…Similar studies with much fewer subjects but using a systolic cut-off of 15 and 20 mmHg found positive predictive values of 100% and 67%, respectively, both with 100% negative predictive values. 10,11 As such, a systolic cuff pressure difference or gradient (in the case of invasive assessment) of > 10 mmHg can be used to delineate hemodynamic significance and justify further investigation.…”

Section: Physical Examinationmentioning

confidence: 99%

Subclavian artery stenosis: A review for the vascular medicine practitioner

2010

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Peripheral artery disease assessment typically focuses on the evaluation of lower extremity symptoms and physical findings. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae. A review of the existing literature through PubMed using the search term 'subclavian stenosis' was performed. The latest original articles, including clinical studies, case reports and limited reviews of this topic were adapted. A comprehensive article review focusing on the diagnostic and treatment approach for subclavian stenosis was prepared. In conclusion, vascular medicine practitioners including cardiologists and vascular surgeons caring for patients with arterial disease should routinely assess for subclavian stenosis. There are excellent screening tools and effective medical therapies which can be instituted if diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness.

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“…The prevalence of significant left subclavian artery stenosis in patients referred for CABG is reported to be 0.2% to 6.8% (1,(11)(12)(13)(14). The prevalence in ESRD patients appears to be higher because peripheral artery diseases coexist more frequently.…”

Section: Discussionmentioning

confidence: 99%

Coronary Subclavian Steal from a Left Internal Thoracic Artery Coronary Bypass Graft due to Ipsilateral Subclavian Artery Stenosis and an Arteriovenous Graft in a Hemodialysis Patient with Left Vertebral Artery Occlusion

et al. 2013

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Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft.

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Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery

Cited by 86 publications

References 8 publications

Measurement and Interpretation of the Ankle-Brachial Index

Measurement and Interpretation of the Ankle-Brachial Index

Subclavian artery stenosis: A review for the vascular medicine practitioner

Coronary Subclavian Steal from a Left Internal Thoracic Artery Coronary Bypass Graft due to Ipsilateral Subclavian Artery Stenosis and an Arteriovenous Graft in a Hemodialysis Patient with Left Vertebral Artery Occlusion

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