Endovascular Management of Aortic Arch Vessel Occlusion: Successful Revascularization of Innominate and Left Subclavian Arteries

• Published in: Vascular and endovascular surgery 2012-04, Vol.46 (3), p.273-276
• Main Authors: Dayama, Anand, Riesenman, Paul J., Cheek, Rick A., Kasirajan, Karthikeshwar
• Format: Article
• Language: English
• Subjects: Angioplasty - instrumentation; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Aortic Diseases - diagnostic imaging; Aortic Diseases - physiopathology; Aortic Diseases - therapy; Aortography; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; Biological and medical sciences; Blood and lymphatic vessels; Brachiocephalic Trunk - diagnostic imaging; Brachiocephalic Trunk - physiopathology; Cardiology. Vascular system; Constriction, Pathologic; Diseases of the aorta; Female; Humans; Medical sciences; Middle Aged; Stents; Subclavian Artery - diagnostic imaging; Subclavian Artery - physiopathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombectomy; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574411436330

A 56-year-old female presented with pain in her bilateral upper extremities. Angiogram demonstrated occlusion of her left subclavian and innominate arteries (IAs). The patient’s left subclavian occlusion was successfully treated with percutaneous mechanical thrombectomy, angioplasty, and stenting. One month later, endovascular revascularization of the IA was performed. Initially the lesion could not be directly transversed from neither an antegrade nor a retrograde approach. Wires were passed from the brachial and femoral arteries into the right common carotid artery where the femoral wire was snared and brought out through the right brachial access. Over this through-and-through wire access, angioplasty and stenting of the IA was performed with an excellent angiographic result. In follow-up, the patient remained free of upper extremity symptoms. Occlusive lesions of the aortic arch vessels can be successfully managed with antegrade and retrograde endovascular techniques.