Spontaneous Subclavian Artery Dissection: A Case Report and Narrative Review

Spontaneous subclavian artery dissection (SSAD) is a rare vascular entity. Its clinical presentation varies significantly, ranging from asymptomatic cases to major neurological events, such as stroke or upper limb ischemia. We present a case of SSAD managed conservatively in a patient who presented with acute upper limb ischemia. A 59-year-old male presented to the emergency department with a 2-hour history of left upper limb pain, with minor motor and sensory deficit, and absence of palpable pulses. Duplex ultrasound revealed an intimal flap in the subclavian artery, while computed tomography angiography (CTA) demonstrated a dissection at the origin of the left subclavian artery that extended to the axillary artery, with distal perfusion impairment. Initial intravenous administration of unfractionated heparin, followed by therapeutic low-molecular-weight heparin during hospitalization, led to improvement in limb perfusion and restoration of palpable pulses. In addition, we provide a narrative review of the literature on SSAD. A search of PubMed, Scopus, Embase, and Google Scholar up to July 2025 identified 18 published case reports describing clinical presentation and treatment strategies. Spontaneous subclavian artery dissection is a rare vascular condition with diverse clinical manifestations and therapeutic approaches. Computed tomography angiography remains the primary diagnostic imaging modality in conjunction with clinical evaluation. Given the limited number of reported cases, there is currently no consensus on optimal management, and treatment should be individualized based on the patient's clinical presentation.