title: Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.
abstract: We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.
authors.affiliation: Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey. cagdasakgullu@gmail.com.
authors.forename: Çağdaş
authors.initials: Ç
authors.lastname: Akgüllü
authors.affiliation: Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Eryılmaz
authors.affiliation: Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
authors.forename: Cemil
authors.initials: C
authors.lastname: Zencir
authors.affiliation: Department of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Güngör
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003937:Diagnosis, Differential; D004562:Electrocardiography; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011859:Radiography; D012039:Regional Blood Flow; D015607:Stents; D013348:Subclavian Artery; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology