title: Subclavian stump syndrome causing a posterior circulation stroke after thoracic endovascular aneurysm repair (TEVAR) with adjunctive carotid to subclavian bypass and endovascular embolization of the left subclavian artery.
abstract: BACKGROUND
  Endovascular repair of thoracic aortic pathology has become increasingly common over the last decade. We highlight the case of an intentionally occluded left subclavian artery stump acting as a source of emboli after thoracic endovascular aneurysm repair (TEVAR) for type B dissection.
  
  
  METHODS
  A 68-year-old man underwent TEVAR of a type B thoracic aortic dissection. A carotid subclavian bypass was performed, and an AMPLATZER™ endovascular plug (to occlude the left subclavian artery origin) was used to create an adequate proximal landing zone.
  
  
  RESULTS
  The patient presented with a posterior circulation stroke 2 years later, which was thought to be due to emboli originating from the occluded subclavian artery stump.
  
  
  CONCLUSIONS
  Consideration should be given to ligating the subclavian artery immediately proximal to the vertebral artery origin when performing adjunctive carotid subclavian bypass during TEVAR. If this is not done, surveillance computed tomography scans should monitor for the development of propagating thrombus in the subclavian stump.
authors: Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand.
authors: Ritesh
authors: R
authors: Patel
authors: Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand. Electronic address: rits106@gmail.com.
authors: Carl
authors: C
authors: Muthu
authors: Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand.
authors: Kwat Huat
authors: KH
authors: Goh
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D002339:Carotid Arteries / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013348:Subclavian Artery; D013577:Syndrome; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed