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Carotid axillary bypass in a patient with blocked subclavian stents: a case report.

Barakat TI, Kenny L, Khout H, Timmons G, Bhattacharya V - J Med Case Rep (2011)

Bottom Line: A diagnosis of subclavian stenosis was confirmed on the basis of a computed tomographic scan and a magnetic resonance angiogram.The patient had undergone subclavian artery stenting twice, and unfortunately the stents blocked on both occasions.She had an uneventful recovery and was able to return to a full, normal life.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, Tyne & Wear, NE9 6SX, UK. tarigbarakat@yahoo.co.uk.

ABSTRACT

Introduction: Surgical treatment of symptomatic occlusive lesions of the proximal subclavian artery is infrequently necessary. Carotid subclavian bypass has gained popularity and is now considered standard treatment when stenting is not possible. Exposure of the subclavian artery and bypass grafting onto it is difficult, as the vessel is delicate, thin-walled and located deep in the supraclavicular fossa. The thoracic duct and brachial plexus are in close proximity to the left subclavian artery and are therefore susceptible to damage. Distal grafting to the axillary artery instead of the subclavian artery has the potential of avoiding some of these risks. Infraclavicular exposure of the axillary artery is more straightforward. The vessel wall is thicker and is easier to handle. In this case report, we describe a patient with a left proximal subclavian occlusion which was stented twice and blocked on both occasions. The patient underwent a carotid axillary bypass, as grafting onto the subclavian artery was impossible because of the two occluded metal stents.

Case presentation: A 56-year-old Caucasian woman, a heavy smoker, presented acutely with left arm numbness and pain and blood pressure discrepancies in both arms. A diagnosis of subclavian stenosis was confirmed on the basis of a computed tomographic scan and a magnetic resonance angiogram. The patient had undergone subclavian artery stenting twice, and unfortunately the stents blocked on both occasions. The patient underwent carotid axillary bypass surgery. She had an uneventful recovery and was able to return to a full, normal life.

Conclusion: Carotid axillary bypass appears to be a good alternative to carotid subclavian bypass in the treatment of symptomatic proximal stenosis or occlusion of the subclavian artery.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance angiogram shows stenosis of the proximal left subclavian artery. Arrow shows area of proximal subclavian artery stenosis.
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Figure 1: Magnetic resonance angiogram shows stenosis of the proximal left subclavian artery. Arrow shows area of proximal subclavian artery stenosis.

Mentions: She was put on an intravenous heparin infusion and magnetic resonance angiography was arranged (Figure 1). Initial angiograms obtained through the femoral artery in the groin showed a tight stenosis which was right at the origin of the subclavian artery. As a result, a guidewire could not be passed through the groin puncture despite several attempts. The brachial route was therefore chosen. A guidewire was passed using a left brachial artery approach through the narrowing. A 5 mm × 4 cm stainless steel stent Genesis (Cordis Endovascular, Warren, NJ, USA) was subsequently deployed and, when ballooned, although it clearly had eliminated the atherosclerotic lesion, the diameter was less than the diameter of the native normal vessel. To improve conformity, the stent was ballooned to 6 mm, which improved the conformity. A good, brisk flow through the stent was confirmed, and the procedure was subsequently completed (Figure 2A).


Carotid axillary bypass in a patient with blocked subclavian stents: a case report.

Barakat TI, Kenny L, Khout H, Timmons G, Bhattacharya V - J Med Case Rep (2011)

Magnetic resonance angiogram shows stenosis of the proximal left subclavian artery. Arrow shows area of proximal subclavian artery stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141696&req=5

Figure 1: Magnetic resonance angiogram shows stenosis of the proximal left subclavian artery. Arrow shows area of proximal subclavian artery stenosis.
Mentions: She was put on an intravenous heparin infusion and magnetic resonance angiography was arranged (Figure 1). Initial angiograms obtained through the femoral artery in the groin showed a tight stenosis which was right at the origin of the subclavian artery. As a result, a guidewire could not be passed through the groin puncture despite several attempts. The brachial route was therefore chosen. A guidewire was passed using a left brachial artery approach through the narrowing. A 5 mm × 4 cm stainless steel stent Genesis (Cordis Endovascular, Warren, NJ, USA) was subsequently deployed and, when ballooned, although it clearly had eliminated the atherosclerotic lesion, the diameter was less than the diameter of the native normal vessel. To improve conformity, the stent was ballooned to 6 mm, which improved the conformity. A good, brisk flow through the stent was confirmed, and the procedure was subsequently completed (Figure 2A).

Bottom Line: A diagnosis of subclavian stenosis was confirmed on the basis of a computed tomographic scan and a magnetic resonance angiogram.The patient had undergone subclavian artery stenting twice, and unfortunately the stents blocked on both occasions.She had an uneventful recovery and was able to return to a full, normal life.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, Tyne & Wear, NE9 6SX, UK. tarigbarakat@yahoo.co.uk.

ABSTRACT

Introduction: Surgical treatment of symptomatic occlusive lesions of the proximal subclavian artery is infrequently necessary. Carotid subclavian bypass has gained popularity and is now considered standard treatment when stenting is not possible. Exposure of the subclavian artery and bypass grafting onto it is difficult, as the vessel is delicate, thin-walled and located deep in the supraclavicular fossa. The thoracic duct and brachial plexus are in close proximity to the left subclavian artery and are therefore susceptible to damage. Distal grafting to the axillary artery instead of the subclavian artery has the potential of avoiding some of these risks. Infraclavicular exposure of the axillary artery is more straightforward. The vessel wall is thicker and is easier to handle. In this case report, we describe a patient with a left proximal subclavian occlusion which was stented twice and blocked on both occasions. The patient underwent a carotid axillary bypass, as grafting onto the subclavian artery was impossible because of the two occluded metal stents.

Case presentation: A 56-year-old Caucasian woman, a heavy smoker, presented acutely with left arm numbness and pain and blood pressure discrepancies in both arms. A diagnosis of subclavian stenosis was confirmed on the basis of a computed tomographic scan and a magnetic resonance angiogram. The patient had undergone subclavian artery stenting twice, and unfortunately the stents blocked on both occasions. The patient underwent carotid axillary bypass surgery. She had an uneventful recovery and was able to return to a full, normal life.

Conclusion: Carotid axillary bypass appears to be a good alternative to carotid subclavian bypass in the treatment of symptomatic proximal stenosis or occlusion of the subclavian artery.

No MeSH data available.


Related in: MedlinePlus