Case images: Angina and vertigo associated with left arm exercise: subclavian artery stenosis in a case with left internal mammary artery graft

Male patient who had LIMA coronary artery by-pass grefting 2 years ago, had left arm claudication, typical angina pectoris triggered with arm movements and a subsequent vertigo. Coronary angiography revealed more than 90% stenosis of the proximal subclavian artery. Saphenous vein angiography showed opacification of LIMA and subclavian artery distal to the stenotic segment,via native coronary arteries.