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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Innominate Artery Stenosis Presenting With Migratory Digital Ischemia
Yen-Yi Juo1, Lisbi Rivas Ramirez2, Garry Ruben2
1Department of Surgery, George Washington University Medical Center, Washington, DC, USA yjuo@gwu.edu.
Migratory digital ischemia can signal rare atherosclerotic disease in major arteries. A combined open and endovascular approach, using carotid control, safely treated innominate artery stenosis and prevented stroke.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Supra-aortic vessel atherosclerosis can cause embolic events or low flow.
- Endovascular treatment of these lesions carries stroke risk due to plaque manipulation.
- Combined operative-endovascular approaches may mitigate intraoperative stroke risk.
Observation:
- An 84-year-old female presented with migratory digital cyanosis progressing to gangrene.
- Angiography revealed severe atherosclerotic plaque and proximal innominate artery stenosis.
- A novel approach involved carotid artery control before retrograde balloon-stent angioplasty.
Findings:
- The combined endovascular-operative intervention was technically successful.
- The patient experienced an uneventful recovery with no new neurological deficits.
- Digital ischemia resolved, with no progression at 2-week follow-up.
Implications:
- Migratory digital ischemia is an uncommon but significant manifestation of supra-aortic atherosclerosis.
- Retrograde angioplasty with distal carotid control offers a safe and effective option for selected patients.
- This approach minimizes embolic risk during endovascular intervention for complex aortic arch lesions.
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