IJCS | Volume 31, Nº2, March / April 2018

103 Figure 4 – Collateral circulation of the LITA to the pelvic region. Figure 5 – Aorta with suboclusive atherosclerotic lesions. Balzan et al. Atherosclerosis in the internal thoracic artery Int J Cardiovasc Sci. 2018;31(2)97-106 Original Article period, leading the patient to perform a myocardial revascularization surgery without effectiveness, since the blood flow of the LITA has its inverted direction, due to subclavian occlusion. 27 In addition, patients may have a characteristic clinical presentation, due to vertebral artery flow also being directed to the subclavian, with symptoms such as dizziness, syncope and vertigo due to the ischemia generated by the deviation of the blood supply. The entire clinical picture generated by this pathophysiology is called the subclavian steal syndrome, and these patients can be screened for both upper limb blood pressure difference, as well as for murmur survey at subclavian level, and pulse difference. Patients with total occlusion of the subclavian artery are at high risk of developing this syndrome before and after CABG. 28-30 The patient in this study was asymptomatic when submitted to angiographic evaluation. The limitation of this study was the small population analyzed, resulting in an absence of relationship between