Complex right subclavian artery dissection during diagnostic cardiac catheterization

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Radiology

Background:

• Vascular complications are known risks associated with cardiac catheterization procedures.
• Dissection of the subclavian artery is a rare but serious complication.
• Right internal mammary artery (RIMA) grafts are used in coronary artery bypass surgery.

Observation:

• A patient developed complex right subclavian artery dissection after attempted diagnostic cardiac catheterization of a RIMA graft.
• The dissection extended to the origins of the right vertebral and internal mammary arteries.
• This resulted in critical ischemia of the right upper limb.

Findings:

• A hybrid treatment approach was employed, combining conservative management for proximal dissections and endovascular stent deployment for distal occlusion.
• Conservative management addressed the vertebral artery and RIMA graft origins.
• Endovascular stenting was used to treat the distal vessel occlusion.

Implications:

• This case underscores the importance of prompt diagnosis and management of vascular complications following cardiac procedures.
• It highlights the necessity of specialized skills in peripheral vascular interventions for managing such complex cases.
• Effective management requires a tailored approach based on the specific anatomy and extent of the dissection.