| Abstrakt: |
Introduction. Occlusion of subclavian artery (SA) most often manifests with symptoms of chronic vertebrobasilar insufficiency as a result of "stealing" blood flow from the cerebral circulation to the ipsilateral upper extremity. It can sometimes present with arm ischemia Clinical case. We present a 69-year-old female patient with high risk and many concomitant diseases, treated in the Clinic of vascular surgery. Medical history: The patient presents with easy fatigability, episodes of vertigo, pain, numbness and weakness during daily activities in the left upper extremity. Accompanying diseases are multicoronary arterial disease, diabetes mellitus with peripheral arterial insufficiency, diabetic retinopathy and neuropathy, and chronic renal insufficiency 3rd stage. Local Status is with no thermo-asymmetry of the arms, no palpable pulsations of left subclavian artery and distally. The difference in blood pressure of right and left brachial arteries exceeded 20 mm/Hg. Color-coded duplex sonography established retrograde blood flow in the left vertebral artery and post-thrombotic blood flow in left SA. CT Angiography of the left upper extremity showed оstial occlusion of the left SA. Digital Subtraction Angiography confirmed the same diagnosis. On clinical discussion, it was considered that, despite the pronounced concomitant diseases, it is appropriate to make an attempt at endovascular revascularization of the left subclavian artery. Intervention: Following pre-dilatation, a stent Isthmus 8/39 mm was inserted in the left SA, which lead to immediate optimal angiographic result. Post-procedure, pulsations of the carpal arteries of the left hand were restored, blood pressure of both brachial arteries were normalized without difference. Complaints of vertigo and weakness in the left upper limb disappeared. Periprocedural nephroprotection was performed, resulting in no deterioration of renal function. Тherapy for home: double antiaggregant therapy for one year - aspirin and clopidogrel, followed by clopidogrel only. The patient continued receiving statins. Conclusion. Endovascular treatment for proximal occlusion of SA is a method of first choice for treatment, especially in polymorbid patients. It is associated with low periprocedural risk and high efficiency for resolution of the lesion, leading to improved quality of life. In the presence of renal failure, periprocedural nephroprotection is of great importance in order to not deteriorate renal function. [ABSTRACT FROM AUTHOR] |
