Abstract
Chronic upper limb ischemia is an uncommon clinical condition and is most often caused by subclavian artery stenosis. Surgical and percutaneous treatment modalities have been shown to be effective for the management of subclavian artery occlusion. Because of lower mortality and morbidity rates, percutaneous interventions for subclavian arterial occlusions are more acceptable than surgery. Chronic total occlusions of the subclavian artery are challenging to treat percutaneously because of the structure and complexity of the lesion. The complexity of the lesion causes its own complications. In this paper, we report a case of a completely occluded left subclavian artery that was complicated by a malpositioned stent hanging into the aortic arch and the ascending aorta during percutaneous intervention, which was successfully managed by our heart team.
Zusammenfassung
Die chronische Ischämie der oberen Extremitäten ist ein ungewöhnliches klinisches Bild und zumeist durch eine Stenose der A. subclavia bedingt. Für chirurgische und perkutane Therapiemodalitäten wurde die Wirksamkeit zur Behandlung der Okklusion der A. subclavia nachgewiesen. Aufgrund niedrigerer Mortalitäts- und Morbiditätsraten sind perkutane Interventionen bei Okklusion der A. subclavia eher angemessen als eine Op. Die perkutane Behandlung eines chronischen Totalverschlusses der A. subclavia stellt wegen der Struktur und Komplexität der Läsion eine Herausforderung dar. Denn die Komplexität der Läsion verursacht ganz eigene Komplikationen. In der vorliegenden Arbeit wird der Fall einer vollständig verschlossenen linken A. subclavia beschrieben, der durch einen fehlpositionierten Stent erschwert wurde, welcher während der perkutanen Intervention im Aortenbogen und in der Aorta ascendens hing, was aber durch das Herzteam der Autoren erfolgreich behandelt wurde.
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Conflict of interest. G. Açar, S. Fidan, G. Alici, M.M. Tabakci, A. Avci, and S. Pala state that there are no conflicts of interest. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.
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Additional material onlineThis article includes six additional Videos. You will find this supplemental at dx.doi.org/10.1007/s00059-013-4005-x.
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Açar, G., Fidan, S., Alici, G. et al. Retrieval of a malpositioned left subclavian artery stent from the ascending aorta. Herz 40, 325–328 (2015). https://doi.org/10.1007/s00059-013-4005-x
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DOI: https://doi.org/10.1007/s00059-013-4005-x