title: Digital embolization due to partially uncovered left subclavian artery post TEVAR: management with amplatzer vascular plug occlusion.
abstract: OBJECTIVE
  To describe the use of the Amplatzer vascular plug to treat a partially uncovered left subclavian artery (LSA) causing digital embolism following thoracic endovascular aneurysm repair.
  
  
  METHODS
  A 70-year-old man presented with digital ischemia of the left index and middle fingers due to embolism from a partially covered LSA orifice during thoracic endovascular aneurysm repair for a type I thoracic aortic aneurysm. The orifice was successfully occluded using the vascular plug, supplemented by a left carotid-subclavian bypass to treat ongoing arm and hand claudication. The patient has had no further embolic episodes.
  
  
  CONCLUSIONS
  A partially uncovered LSA during thoracic endovascular aneurysm repair poses a risk of thromboembolism, with resultant upper limb claudication or tissue loss. If recognized at the time of the procedure, this should be treated by proximal extension; otherwise, proximal LSA occlusion using an Amplatzer occluder may be a safe and effective option in preventing further embolic episodes.
authors.affiliation: Department of Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia. a.chaudhuri@tiscali.co.uk
authors.forename: Arindam
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tibballs
authors.forename: Sanjay
authors.initials: S
authors.lastname: Nadkarni
authors.forename: Marek
authors.initials: M
authors.lastname: Garbowski
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome