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Cardiovasc Interv Ther. 2015 Jul;30(3):279-82. doi: 10.1007/s12928-014-0284-2. Epub 2014 Jul 16.

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

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  • 1Division of Cardiovascular Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, MS #1118, Toledo, OH, 43614-2598, USA,


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.

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