Perioperative management - PTA of a left subclavian artery stenosis (balloon angioplasty)

Stenosis or occlusion of the subclavian artery only in cases of clearly attributable symptoms/hypoperfusion of the arm:

• claudication-like arm complaints (load-dependent ischemia)
• acral lesions in the finger area
• Subclavian Steal Syndrome

• asymptomatic stenosis of the subclavian artery
• systemic diseases, e.g. Takayasu arteritis

Medical History

Ischemia-related complaints

• rapid fatigue of the arm, claudication-like complaints during overhead work

Inspection/Palpation

• Pallor and coldness of the hand
• weakened pulse (brachial, radial, ulnar arteries)
• acral cyanosis, also necroses due to embolic digital artery occlusions (e.g., due to thrombi in a post-stenotically dilated subclavian artery)

Blood Pressure Measurement

• on the affected side, blood pressure usually > 30 mm Hg lower

Doppler Duplex Sonography

• The brachiocephalic trunk and the origin area of the left subclavian artery are usually not directly accessible due to anatomical reasons
• from the flow spectrum of the more cranial arterial segments, however, stenoses in the inflow can be inferred

Imaging

• MR or CT Angiography

• Marking of the side to be operated on
• if necessary, shaving of the puncture site

• Change of access route, e.g. transfemoral -> cubital
• Allogeneic blood transfusion, Hepatitis, HIV
• Allergic reaction, e.g. contrast medium
• Contrast-induced nephropathy, possibly lifelong dialysis
• Hematoma/secondary bleeding groin
• Vessel dissection in the groin or pelvic arteries necessitating possibly open surgical correction
• AV fistula formation, pseudoaneurysm in the groin necessitating surgical correction
• Groin infection, deep infection, sepsis
• Lesion of the femoral nerve
• Thromboembolism (myocardial infarction, renal infarction, intestinal necrosis) -> local lysis, fibrinolysis
• Re-stenosis
• Conversion to open surgery