Ryan D. Andal has completed his College at the age of 18 years from De La Salle University Manila with a degree in Medical Physics and postdoctoral studies from University of Santo Tomas , Manila.   He trained in internal medicine at the Makati Medical Center and his 3rd year of fellowship in cardiology.  He is board certified in Internal Medicine and plans to pursue interventional cardiology after his fellowship training.  


Coronary subclavian steal syndrome is a rare disorder, mostly unrecognized and underdiagnosed , seen in patients developing subclavian artery (SA) stenosis after Coronary Artery Bypass Graft (CABG)  using the LIMA –LAD graft diverting blood flow from the native coronary LAD back to the graft LIMA –LAD into the  subclavian artery in a retrograde fashion. This is also the same for the vertebral artery where blood is diverted back from the brain into the subclavian artery.
This disorder causes significant symptoms which is brought about by ischemia coming from the heart, left upper extremity and the brain . It is a catastrophic event where only very few case reports have been described and reported .Moreover, it has been also described that a coronary steal from a LIMA graft post CABG can present as angina while undergoing hemodialysis. This phenomenon is documented through  cardiac catheterization with evidence blood flow steal from the internal mammary artery graft while on dialysis, without subclavian subclavian artery stenosis.
This is a case report of  a patient with coronary-subclavian steal syndrome caused by a proximal subclavian artery stenosis in a post CABG patient with a LIMA-LAD graft aggravated by ongoing dialysis using AV fistula on the left arm.  A combination f 2 phenomena that can lead to detrimental outcome if not treated appropriately though revascularization.