PMC7491219_01
Left anterior oblique projection of aortic arch angiogram. The stump of the right subclavian artery is seen overlapping the left subclavian artery origin (white arrow). No distal right subclavian artery is seen. The right vertebral artery originates from the right common carotid artery (black arrow).
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Because right subclavian artery disease was also suspected based on arm symptoms and discordant arm blood pressures, arch aortography was performed at that time, demonstrating the stump of an occluded ARSA (Figures 1 and 2).
Right anterior oblique projection of aortic arch angiogram clearly demonstrating the stump of the aberrant right subclavian artery.
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Because right subclavian artery disease was also suspected based on arm symptoms and discordant arm blood pressures, arch aortography was performed at that time, demonstrating the stump of an occluded ARSA (Figures 1 and 2).
Delayed imaging after left anterior oblique aortic arch angiogram showing late filling of the distal right subclavian artery.
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Delayed imaging demonstrated collateral flow opacifying the distal vessel after a 60-mm occluded segment (Figure 3).
Simultaneous angiography of the stump of the aberrant right subclavian artery from femoral artery access (black arrow) and retrograde subclavian angiography from brachial access.
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The procedure was performed using right femoral artery and ultrasound-guided right brachial artery access (Figure 4).
Retrograde wire passage from right brachial access, through the subclavian occlusion, and into the sheath placed from femoral access.
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This created a plane through which the brachial wire and multipurpose catheter could be advanced into the awaiting 6-Fr sheath (Figure 5).
Final angiography demonstrating resolution of aberrant right subclavian occlusion by stent placement.
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After treatment, there was no residual stenosis (Figure 6) and no pressure gradient between the aorta and right brachial artery.
CT angiographic image obtained at 5-year follow-up demonstrating a patent ARSA stent (white arrow).
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A chest computerized tomography (CT) was performed 5 years after the procedure, demonstrating a patent stent (Figure 7).