Upper Limb Ischemia by Subclavian Artery Dissection after Osteopathic Manipulation

Area of Science:

• Vascular Surgery
• Neurology
• Osteopathic Medicine

Background:

• Osteopathic manipulative treatment is a complementary therapy.
• Cervical manipulation has been anecdotally linked to arterial dissection.
• Subclavian artery dissection is a rare but serious complication.

Observation:

• A young woman developed upper limb ischemia following osteopathic manipulation.
• Diagnostic imaging revealed a hematoma at the ostium of the subclavian artery.
• The patient experienced spontaneous resolution of symptoms without surgical intervention.

Findings:

• The case demonstrates subclavian artery dissection as a cause of upper limb ischemia after osteopathic manipulation.
• This presentation differs from previously reported vertebral and carotid artery dissections linked to manipulation.
• The vascular complication was diagnosed using duplex ultrasonography and computed tomography angiography.

Implications:

• Arterial dissection following manipulation warrants careful consideration of vascular risks.
• Establishing a registry for manipulation-associated arterial dissections is crucial for risk assessment.
• Further research is needed to understand the incidence and mechanisms of these vascular events.