Successful Management of Incidentally-Detected Subclavian Stenosis During Anesthetic Preparation for Spinal Surgery: A Case Report.

Abstract

Background: Subclavian artery stenosis is mainly caused by atherosclerotic changes, which may result in ischemic events in the upper limbs and the central nervous system. Other etiological causes include radiation exposure, vasculitis, neurofibromatosis, external compression syndrome, and fibromuscular dysplasia. The conventional anesthetic challenge for these patients is to maintain cerebral perfusion.

Case presentation: We present a case of incidentally discovered left subclavian stenosis in a 65-year-old male who was admitted for spinal surgery. The patient had a history of peripheral arterial disease, diabetes mellitus, and heavy smoking. During the preoperative assessment, the blood pressure readings in the department were within the normal range. In the operating theater, blood pressure readings of the two arms revealed readings of 136/85 mmHg and 235/114 mmHg in the right and left arms, respectively. Accordingly, the operation was postponed for further evaluation of the increased interarm systolic blood pressure difference. Computed tomography angiography revealed focal stenosis at the origin of the left subclavian artery, causing approximately 90% narrowing. The patient underwent a successful subclavian artery angioplasty.

Conclusion: It is important to report BP readings of blood pressure in both arms of patients with a history of peripheral arterial disease, heavy smoking, or severe metabolic syndrome. Patients with subclavian stenosis are prone to increased inter-arm systolic blood pressure difference. Accordingly, the bilateral measurement of BP is a simple test with valuable impact on the preanesthetic assessment in an emergency setting.