title: Complex right subclavian artery dissection during diagnostic cardiac catheterization.
abstract: Vascular complications are important and unfortunate sequelae of cardiac catheterization. We report a case of complex right subclavian artery dissection following attempted diagnostic cardiac catheterization of a right internal mammary artery (RIMA) coronary bypass graft. Subsequent dissection of the right subclavian artery involved the origin of the right vertebral and internal mammary arteries, as well as producing critical right upper limb ischemia. The anatomy dictated that therapy consist of conservative management of the proximal dissection involving the vertebral artery and the RIMA graft origins, with endovascular stent deployment at the distal site of the vessel occlusion. This example reinforces the need for prompt diagnosis and management of vascular complications, and emphasizes the need for available, appropriate skills relevant to the peripheral vascular interventions.
authors.affiliation: Interventional Cardiology Program, Division of Cardiology, University Health Network/Toronto General Hospital, 585 University Avenue, Toronto, Ontario, Canada. Eric.Horlick@uhn.on.ca
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Collins
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beecroft
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D011859:Radiography; D015607:Stents; D013348:Subclavian Artery / Q000293:injuries* / Q000601:surgery