Treatment of an iatrogenic subclavian artery dissection

Endovascular Management of Spontaneous Subclavian Artery Dissection

Spontaneous subclavian artery dissection (SCAD) is a rare clinical observation with very few cases reported in the medical literature. We describe a rare case of a 50-year-old female patient who presented with symptoms of critical limb ischemia of the right upper extremity. A digital subtraction angiogram (DSA) revealed a dissection in the proximal course of the subclavian artery (SCA). Prompt recanalization with endovascular therapy produced an excellent result.

Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions

Background

Coronavirus disease 2019 (COVID-19) is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity, yet it also causes multiple organs dysfunction in affected patients. There is a strong evidence that it increases the susceptibility of cerebrovascular strokes in such patients. Besides this prothrombotic complication, arterial dissection can be one of its mechanisms increasing the risks of stroke.

Case presentation

Herein, we report a case of spontaneous isolated subclavian artery dissection in a COVID-19 patient. Sixty-one-year-old female presented with spontaneous isolated subclavian artery dissection without any traumatic events nor history of connective tissue disorders. She had left upper limb ischemia followed by cerebellar, thalamic and occipital infarctions. Whether this patient’s subclavian artery dissection was triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative.

Conclusions

Nonetheless, arterial dissection can be one of its complications, it is essential for treating physicians to be attentive for the diversity of COVID-19 clinical manifestations.

Retrograde dissection of the axillary artery during arteriogram via arteriovenous access

INTRODUCTION

Retrograde arterial dissection is a recognized complication of endovascular intervention but has not been well reported especially in the context of dialysis arteriovenous access procedures. The management of this complication is also not well defined.

CASE PRESENTATION

We report the case of an 80-year-old female with end-stage renal disease (ESRD) on dialysis who developed an asymptomatic retrograde dissection of the left axillary artery during an arteriogram performed via a retrograde approach as part of access dysfunction evaluation. The condition was managed conservatively with no other intervention and close follow-up. No surgical intervention or stenting was needed in this case.

DISCUSSION

Conservative management of retrograde arterial dissection in the arm may be a viable option especially in asymptomatic patients due to the nature of the injury. The force of blood flow in the antegrade direction limits the expansion of the false lumen and likely promotes the spontaneous healing of the vessel.

Complete stent fracture 1 year after LIMA PCI due to LIMA and subclavian artery dissection

Stent platforms are prone to fracture while incidental data are demonstrating a potential unfavorable outcome. Predisposing factors usually involve long lesions and tortuous vessels requiring more than one stent. This issue is magnified when it involves a periprocedural iatrogenic left internal mammary artery (LIMA) and subclavian artery dissection. In such complex clinical scenarios, the risk of potential complications including stent fractures is thought to be higher, though there is no data to determine the prognosis or to outline the outcomes of any management option. We present a case of complete stent fracture 1 year after LIMA percutaneous coronary intervention due to LIMA and subclavian artery dissection highlighting the circumstantial evidence in the literature that guided our management decisions.

Conservative management in a young woman affected by isolated left subclavian artery dissection

Subclavian Artery Dissection (SAD) is a rare condition, generally due to arterial catheterization, blunt trauma or connective tissue disease. Spontaneous or minimally traumatic cases have also been reported. Clinical manifestations are usually chest and/or back pain, pulse loss and paresthesia, whereas nausea, dizziness and vomiting are present in case of involvement of the vertebral artery. We report an unusual case of a young woman presenting isolated left SAD after traffic accident, minimally symptomatic, and treated with medical therapy alone. A conservative management and a closed follow-up appear to be a safe approach in patients affected by uncomplicated SAD without other comorbidities.