Spontaneous left subclavian artery dissection with concurrent thrombosis and embolic occlusion of the lower limbs: Report of a case

Abstract

A subclavian artery dissection (SAD) is usually associated with coexisting aortic disease, and spontaneous SAD is extremely rare. This report presents the case of a spontaneous SAD patient who developed atypical clinical symptoms. A 41-year-old woman presented with bilateral ischemia of her lower limbs. An urgent bilateral femoral thrombo-embolectomy was performed using a balloon catheter. Postoperative enhanced computed tomography (CT) demonstrated a localized thrombus in the left subclavian artery extending toward the descending thoracic aorta, and a follow-up CT angiogram obtained 3 months later revealed left SAD and complete resolution of the thrombus. The patient was anticoagulated with warfarin in addition to antiplatelet drugs after the balloon catheter thromboembolectomy. This is the first report of lower limb ischemia caused by an embolism from a mural thrombus of the descending thoracic aorta extending from spontaneous SAD.

Localized Right Subclavian Artery Dissection Detected by Accident on an Ultrasound Examination: A Case Report and Literature Review

“…Among eight patients with spontaneous LSAD, four had high blood pressure (6,8,9,11) one had arteriosclerotic disease (7), and the other four had no specific underlying disease. Left subclavian artery dissection was detected in seven cases (6-9,11-13), possibly because the pulsatile flow is stronger in the left than in the right subclavian artery (14). The main symptoms were pain in the shoulder, neck, chest, and upper limbs on the affected side (6-10,12).…”

“…Nine cases of LSAD with complications have been reported previously (3,5,7-13), including three cases of cerebellar infarction due to vertebral artery occlusion (7-9), three cases of axillary and brachial artery thromboembolism (anterograde) (3,5,12), one case of femoral artery thromboembolism (retrograde) (11), and two cases of hemorrhaging caused by arteriorrhexis, resulting in death (10,13). Six patients showed progression of the dissection after stroke (3,9-13), including five patients with spontaneous LSAD (9-13).…”

Spontaneous rupture of the branches of left subclavian artery

“…HBP, no matter acute, or chronic, was very common in LSA dissection, showing that LSA received stronger pulsatile flow than the right subclavian artery (RSA). [ 2 , 3 ] Two patients caused by trauma that may have a high mortality. LSA rupture was also reported in postpartum period of pregnancy patient.…”

Conservative Management in a Young Woman Affected by Isolated Left Subclavian Artery Dissection

“…6,7) The incidence is higher in females of fourth to fifth decade suffered by hypertension. 8) Back pain radiating to the precordium, 2) chest or neck pain 3,11) and dullness 8) are typical initial manifestations of isolated SAD. Claudicatio 6) of upper limb, up to ischemic phenomena are reported, even if the collateral circulation of the shoulder may provide a sufficient compensation of the arm.…”

“…Claudicatio 6) of upper limb, up to ischemic phenomena are reported, even if the collateral circulation of the shoulder may provide a sufficient compensation of the arm. 3) The involvement of VA determines "posterior symptoms" such as nausea, dizziness and vomiting, 9) up to stroke, 10) while a dissection towards the vessels of the arm or the aorta can result in back pain radiating to the precordium, 2) chest pain, 3) neck pain, 11) dullness 8) or claudicatio 6) of upper limb, up to ischemic phenomena. 12) Physical examination detects typically different blood pressure between arms and/or signs of unilateral upper limb ischemia.…”