Subclavian Artery Disease

[Bestdoll]

I have had Coronary Artery Bypass surgery 6 years ago for the LAD and D2. A LIMA graft was used and after 6 months the surgery was a failure. Fortunately, the native vessels were opened with angioplasty and stenting. The small D2 was a yearly problem that required multiple cardiac cath. interventions. Angina was a continuous problem, even after the D2 had 2 stents. Over 3 years, Angina was not relieved with nitroglycerin.There were times of no symptoms for 3-6 weeks and most times debilitating symptoms for months. Aching in chest, left arm, profound weakness. I always said to the Cardiologist.."Whats with the upper arm activity"? after washing my face, aching and weakness occurs in the arms and chest. It took 2-3 hours to recuperate from this draining feeling. At work, I would raise my arm for a record in the cabinet and the same occurred. Recently, I searched and found out there are other arteries that can be diseased. I asked the Dr. to order a Doppler Ultrasound, which he did. This was done in November,'13. At the time of the test i was feeling good and had no symptoms.  Although there were no changes in pressures, the test was positive for subclavian artery disease of both right and left arteries. Mild occlusive disease bilaterally. I made an appt. with a Vascular Surgeon which is coming up January 13 2014. I am symptomatic since December. I cant do anything using my arms. I am Left handed. I have a continuous aching in the left shoulder and chest. It wipes out all energy. While the term mild is in the report, I have major symptoms. What can I expect from this Dr. in terms of the discrepency of symptoms related to the mild report. Will he hunt for an occlusion or intermittent compression elswhere? and where is elsewhere? I do have near faint episodes after bending, but attribute that to meds. I had 2 episodes of blurred vision in December. Thought it was the 2 hour drives. Should I have concerns about the Aortic arch? I need a Proactive hunt for the etiology of this severe problem which has taken the simple activities in life away from me. Thank you for your interest. Grace

[Bestdoll]

In general, my cardiologist passes up on tests that eventually lead to a cath. i called the interventionalist this morning to see if he does angio's other than Coronary. I faxed my report and he reviewed it with an interventionalist that does non coronary intervention. I am now on schedule for Monday, in New York. Now thats the speed I like! Would have preferred this 3 years ago, but no one thought.

[Bestdoll]

Yes, I am on statins. this angina is activity related. I wonder about a compression situation. 4 months  post surgery my sternum was crunching. The Manubrium was in 3 pieces, the wires were going through the sternum, and the bones were not fused. I was told my sternum is small and thin and needed more than the usual wires to hold it. i wonder about thoracic outlet syndrome which is related to an extra rib or abnormal first rib. Although I dont have this, I think about the loose upper sternum fusing abnormally and causing a compression on the subclavian.
Thank you for your interest.

[ed34]

Yes an angiogram is the gold standard. I have to ask though what meds you are on? were you put on statins at the time your problems started? aches and pains can be associated with this medication and usually a patient is switched to a different brand.

[Bestdoll]

Thank you. I had a  Cardiac stress MRa in May which was for the coronaries.
One would think all vessels were seen but not all are reported on. But yes, I wonder if they will do a Cta or a femoral angiogram. The CTa is non invasive but is a angiogram more conclusive.
Thank you again,
Grace

[ed34]

You obviously have a problem which needs to be found. Whether it's a blood circulation issue or not, this needs investigation. If the vascular expert feels that there is nothing severe enough to be causing the problems, then I would ask what else he thinks it could be. Perhaps they could run a ct angio of your upper body to see if anything obvious shows up.