每日一题_2024.12.14

A 63-year-old man with a history of coronary-artery bypass grafting presented with a 2-month history of angina that occurred during exertion of the left arm. Five years before presentation, he had undergone grafting of the left internal thoracic artery (LITA) to the left anterior descending (LAD) coronary artery. The blood pressure was 128/84 mm Hg in the right arm and unmeasurable in the left arm. On physical examination, the brachial and radial pulses on the left side were feeble. A computed tomographic angiogram of the aorta and neck vessels showed total occlusion of the subclavian artery on the left side, proximal to the origin of the LITA. Which of the following is the most likely diagnosis?

一位63岁男性，有冠状动脉旁路移植手术史，主诉左臂活动时出现2个月的心绞痛。五年前，他接受了左胸内动脉（LITA）到左前降支（LAD）冠状动脉的移植手术。右臂血压为128/84毫米汞柱，左臂血压无法测量。体格检查发现左侧的肱动脉和桡动脉搏动微弱。主动脉和颈部血管的计算机断层血管造影显示左侧锁骨下动脉完全闭塞，位于LITA起始点的近端。以下哪个诊断最有可能？

A. Aortic Arch Syndrome主动脉弓综合征

B. Congenital Atretic Subclavian Artery先天性闭锁性锁骨下动脉

C. Coronary-Artery Bypass Graft Failure冠状动脉旁路移植失败

D. Coronary-Subclavian Steal Syndrome冠状-锁骨下动脉窃血综合征

E. Thoracic Outlet Syndrome胸廓出口综合征

答案解析：

冠状动脉造影在左主干注射造影剂显示LITA移植物从LAD冠状动脉向左锁骨下动脉逆行流动。诊断为冠状动脉锁骨下窃血综合征。当临床上明显的锁骨下动脉狭窄靠近同侧胸椎内动脉移植物的起源地，导致通过胸椎内动脉的血流逆转，远离冠状动脉循环，导致手臂运动时心绞痛时，发生锁骨下动脉狭窄综合征。

正确答案：D