Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis

Peter W Hashim; Roland Assi; Loreta Grecu; Alan Dardik

doi:10.1016/j.avsg.2013.04.030

Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis

Ann Vasc Surg. 2014 Apr;28(3):737.e1-5. doi: 10.1016/j.avsg.2013.04.030. Epub 2013 Dec 22.

Authors

Peter W Hashim¹, Roland Assi², Loreta Grecu³, Alan Dardik⁴

Affiliations

¹ Department of Surgery, Yale University School of Medicine, New Haven, CT.
² Department of Surgery, Yale University School of Medicine, New Haven, CT; Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT.
³ Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.
⁴ Department of Surgery, Yale University School of Medicine, New Haven, CT; Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven, CT. Electronic address: alan.dardik@yale.edu.

PMID: 24368183
DOI: 10.1016/j.avsg.2013.04.030

Abstract

Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.

Published by Elsevier Inc.

Publication types

Case Reports

MeSH terms

Aged
Angioplasty, Balloon / instrumentation
Aortic Valve Stenosis / complications*
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery
Arterial Occlusive Diseases / complications*
Arterial Occlusive Diseases / diagnosis
Arterial Occlusive Diseases / physiopathology
Arterial Occlusive Diseases / therapy
Brachiocephalic Trunk* / physiopathology
Constriction, Pathologic
Diagnostic Errors
Dizziness / etiology
Female
Heart Valve Prosthesis Implantation
Hemodynamics
Humans
Muscle Weakness / etiology
Predictive Value of Tests
Stents
Subclavian Steal Syndrome / diagnosis
Subclavian Steal Syndrome / etiology*
Subclavian Steal Syndrome / physiopathology
Subclavian Steal Syndrome / therapy
Syncope / etiology
Treatment Outcome
Ultrasonography, Doppler, Color