PTA of a left subclavian artery stenosis (balloon angioplasty)

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Puncture of the right common femoral artery
Advancing the sheath up to the aortic arch
Angiography
Probing of the Subclavian Stenosis
Balloon dilatation
Post-dilatation using DEB balloon catheter
Control Angiography

Authors

Dr. med. Zmarai Nurzai

Dreifaltigkeits-Hospital Lippstadt

Date

date of publication: 02.01.2021

surgery report

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Puncture of the right common femoral artery

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Infiltration anesthesia right groin with Xylonest 1%. Palpation and puncture of the common femoral artery. Insertion of a Terumo® wire through the puncture cannula.
Advancing the sheath up to the aortic arch

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Advancing the Terumo® wire under fluoroscopic control centrally as well as placing a long sheath (length 70-90 cm, diameter 6-8 French). Under fluoroscopy, the sheath is advanced up to the aortic arch. Then administration of 5000 IU heparin systemically.
Angiography

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Visualization of the supra-aortic branches, particularly the left subclavian artery. Marking of the origin of the subclavian artery from the aortic arch as well as its stenosis.
Tips:
1. For better visualization of the supra-aortic branches in awake patients, the patient should first be instructed to breathe deeply in and out, then the angiography is performed during a breath hold.
2. The aortic arch should be displayed anatomically correctly. To do this, the C-arm should be positioned in LAO between 30 and 50° (LAO projection = left anterior oblique, left anterior oblique position).