Complete revascularization of total obstruction of both subclavian arteries and descending abdominal aorta by combined surgery and percutaneous transluminal angioplasty

A 48-year-old man was admitted with chest pain, intermittent claudication and right upper extremity weakness. Magnetic resonance angiography revealed total occlusion of both subclavian arteries and descending abdominal aorta below renal artery. End-to-side aorta to bifemoral graft surgery and percutaneous transluminal angioplasty of both subclavian arteries were performed. Follow-up angiography after 6 months revealed patent left subclavian artery but 70% occluded right subclavian artery. Therefore re-intervention was performed at right subclavian artery.