Coronary Subclavian Steal Syndrome Detected During Coronary Bypass Surgery in a Hemodialysis Patient

Coronary subclavian steal syndrome is a concern in hemodialysis patients with an upper extremity arteriovenous fistula (AVF) who are undergoing ipsilateral IMA harvest for revascularization.  In this case report, the authors describe the intraoperative documentation of reversal of flow in the LIMA to LAD graft that improved with occlusion of the AVF.  This finding prompted taking the LIMA off the Aorta as a free graft, which led to improvement of flow characteristics.