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JAMA Surgery Clinical Challenge
April 2018

Progression in a Patient With Previously Treated Atherosclerotic Disease

Author Affiliations
  • 1Division of Vascular and Endovascular Surgery, University of California San Francisco Medical Center, San Francisco
JAMA Surg. 2018;153(4):380-381. doi:10.1001/jamasurg.2017.6097

A 71-year-old man with a history of coronary artery bypass graft using the left internal mammary artery (LIMA) to the left anterior descending (LAD) in 1997 presented with frequent ventricular tachycardia on routine pacemaker interrogation. He reported dyspnea on exertion and left leg claudication at 23 m. At rest, his blood pressure was 146/65 mm Hg measured on the right arm and 85/50 mm Hg on the left arm. Physical examination was notable for a diminished left radial pulse. In 2014, he experienced angina that resolved following placement of a drug-eluting stent in his LAD. Coronary angiography via the left femoral artery is displayed in the Figure.

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