Coronary-subclavian steal syndrome is a potential complication of coronary artery bypass grafting when the internal mammary artery is used as a conduit. Concomitant carotid artery disease complicates the syndrome by introducing a possible simultaneous cerebral steal phenomenon. The authors present the first reported case of a patient who had symptomatic coronary-subclavian steal with significant carotid occlusive disease. An axilloaxillary bypass was performed instead of the standard carotid-subclavian bypass. Recommendations concerning the diagnosis and management of this syndrome are presented and the indication for axilloaxillary bypass is outlined.
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