Atypical and rare cause of myocardial infarction: coronary subclavian steal syndrome (CSSS) treated by a carotid-subclavian bypass in a 71-year-old female patient.

BACKGROUND: The coronary subclavian steal syndrome (CSSS) is a rare complication after coronary arterial bypass graft operations (CABG) using the left or right internal mammary artery ((L/R)IMA). It results from a retrograde blood flow from the IMA into the subclavian artery (SA) due to a stenosis or occlusion of the SA proximal to the IMA origin. This "steal phenomenon" leads to a decreased blood flow in the IMA and may result in myocardial ischemia (MIS) and even myocardial infarction (MIN). Treatment options include interventional and surgical therapy. CASE PRESENTATION: We report the case of a 71-year old woman, who suffered from an acute non-ST elevation myocardial infarction (NSTEMI) 11 years after LIMA-CABG surgery and who was treated successfully with a carotid-subclavian bypass (CSB) after failed interventional therapy. CONCLUSION: CSB may be regarded as a viable treatment option for patients suffering CSSS in the case of MIS and even an acute MIN/NSTEMI, especially in the case of missing or failed interventional therapy attempts. Specialists in cardiothoracic and vascular surgery should be aware of possible CSSS conditions and know about appropriate diagnostic and therapeutic options.

Irreducible Lisfranc dislocation due to the interposition of the tibialis anterior tendon: case report and literature review.

We report a case of a lateral type A (according to Myerson) Lisfranc dislocation irreducible by closed manipulation. Upon surgical exploration the lateral slip of the tibialis anterior tendon was found trapped between the medial and the middle cuneiform. Once the tendon was reduced, the dislocated first ray spontaneously reverted to its anatomical position and the joint was fixed with Kirschner wires. Seven similar cases have been reported in the literature. After analysis of all the reported cases we were able to describe a pattern of injury that may predict tibialis anterior interposition: (a) lateral type A according to Myerson dislocation; (b) after closed manipulation the 1st ray remains dislocated while the 5th metatarsal reduces; (c) there is a gap between the medial and the middle cuneiform or a fracture at the base of the 2nd metatarsal.