title: Iatrogenic subclavian artery and aortic dissection with mesenteric ischemia following subclavian artery angioplasty: Endovascular management.
abstract: Subclavian stenosis affects up to 5% of patients referred for coronary artery bypass grafting. Albeit usually asymptomatic, this condition can cause myocardial ischemia due to a steal phenomenon from the distal subclavian artery when the left internal mammary artery is used as a coronary bypass. We describe a case of proximal subclavian artery angioplasty complicated with aortic dissection and subsequent life-threatening mesenteric ischemia. For the first time, we illustrate an endovascular approach to both complications consisting in urgent stenting of the celiac trunk and the superior mesenteric artery followed by staged thoracic endovascular aortic repair due to progressive aortic dilatation.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université De Montréal, Québec, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Millán
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université De Montréal, Québec, Canada.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université De Montréal, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dorval
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D015150:Echocardiography, Doppler / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D018570:Risk Assessment; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: aortic endograft; coronary-subclavian steal syndrome; mesenteric stenting; subclavian stenosis