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Treatment of an iatrogenic subclavian artery dissection

Christian Spies1, David Fergusson

  • 1Department of Cardiovascular Diseases, The Queen's Medical Center, Heart Physician Practice, 550 S. Beretania Street, Honolulu, HI 96813, USA. cspies@queens.org

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 26, 2010
PubMed

Insights

Subclavian artery dissection, a rare cardiac catheterization complication, can occur years after bypass surgery involving a left internal mammary artery (LIMA) graft. Successful treatment involved angioplasty and stent placement via a retrograde left brachial approach.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Subclavian artery dissection is an uncommon complication following cardiac catheterization.
  • Accessing the left internal mammary artery (LIMA) origin is a common indication for subclavian artery catheterization, particularly in patients with prior or planned coronary artery bypass grafting (CABG).

Observation:

  • This report details a case of subclavian artery dissection that manifested long after the patient underwent bypass surgery utilizing a LIMA graft.
  • The dissection occurred during a cardiac catheterization procedure.

Findings:

  • The dissection was successfully treated using angioplasty and stent placement.
  • A retrograde left brachial artery approach was employed for the intervention.

Implications:

  • This case highlights the potential for delayed complications of subclavian artery access in patients with LIMA grafts.
  • The retrograde brachial approach offers a viable alternative for managing such complex dissections.
  • Further research may elucidate optimal surveillance strategies for patients with LIMA grafts undergoing cardiac procedures.

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