Internal mammary artery steal in a dialysis patient

A 67-year-old man with chronic renal failure who was being treated with dialysis through an arteriovenous fistula in the left arm was scheduled to undergo off-pump coronary artery bypass grafting. Angiography detected the steal phenomenon in the left internal mammary artery during the diastolic phase. Postoperative study with Doppler guidewire showed that the steal of the left internal mammary artery was due to an ipsilateral arteriovenous fistula. Preoperative angiography of the internal mammary artery is therefore recommended for patients on dialysis.