Subclavian Artery Dissection; A Rare Complication of Transradial Angiography
A 52-year-old female patient presenting with typical angina pectoris was admitted to the cardiac catheterization laboratory with evidence of inferior left ventricular wall ischemia detected by myocardial perfusion scintigraphy spect. A short, 6 Fr sheath was inserted into the right radial artery and a 5 Fr radial diagnostic catheter (Optitorque; Terumo Corporation) and 0.035˝ 260 cm 260 cm “J” tip wire were used for diagnostic coronary angiography. While the guidewire was advanced to reach the ascending aorta, there was resistance on the right subclavian artery. The guidewire was withdrawn and selective right subclavian angiogram was performed that demonstrated the dissection of subclavian artery (Figure 1).
Akımı engellemiyor ise müdahaleye gerek yoktur. Diseksiyon girişi akımın ters yönünde olduğu için spontan kapanabilir. Diseksiyon ilerler ve akımı engellerse uzun süreli balon şişirme veya stent ile tedavi düşünülebilir.
Dear Ersan Tatli,
First of all I would do nothing, waiting if there is any clinical alteration . If the patient does not show any symptoms I would do only image monitoring for a time . One /tree /six months and one year .
If she is sintomatic after the procedure I wold treat with a stent.
Hi Ersan, I would anticoagulate the patient to avoid great vessel thrombosis. Then, if patient is still asymptomatic, perform serial Doppler monitoring, repeat angio in one month and if still dissected, consider to stent anterogradely through femoral access.
I would anticoagulate and wait unless the cardiac symptoms or vascular insufficiency in the arm are serious or progressive. If intervention is needed I would like to do a surgical repair a the injury is close to the origin of the artery.
If the patient is asymptomatic I do nothing. If the patient shows symptoms in the evolution, stent implantation is a safe procedure.
The wall of the subclavian artery is not a very stabile structure. The patient may develope an aneurysm. I would follow the patient in close intervals by ultrasouns or CT, and evaluate the possibility of covered stent implantation.
In absence of symptoms I would perform a close monitoring with US and CT. If any worsening is seen I would implant one or more stents to close dissection.
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