title: 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.
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shin-koji, Nobeoka, Miyazaki, 882-0835, Japan.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Nakamura
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakamura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuyama
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Niina
authors.forename: Hirohito
authors.initials: H
authors.lastname: Ishii
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications*; D000925:Anticoagulants / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000150:complications*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology*; D035002:Lower Extremity / Q000098:blood supply*; D013348:Subclavian Artery / Q000601:surgery*; D013923:Thromboembolism / Q000209:etiology*
chemical_list: D000925:Anticoagulants