Done CABG 10 years back. Having recurrent attacks of giddiness and difference in blood pressure in both the upper limbs since last 6 months. His left radial and brachial pulses are very feeble. 98 revealed severe native coronary artery disease with all venous grafts blocked. Severe triple vessel disease.
Native vessels are tiny.
Carotid Doppler shows large left vertebral with retrograde flow. Otherwise normal carotid and vertebral arteries. I understand that a carotid subclavian bypass using prosthetic dacron has the risks of stroke, heart attack, damage to phrenal nerve to diaphragm, damage to auditory nerve, damage to thoracic lymph duct. On the other hand, stent placement has the risk of clot going into and blocking the LIMA and thus putting life at risk. Also in-stent restenosis is another problem.