Alhowary Ala A, Gharaibeh Saif, Aleshawi Abdelwahab
Department of Anesthesiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan.
Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan.
Int Med Case Rep J. 2025 Jun 12;18:699-704. doi: 10.2147/IMCRJ.S515664. eCollection 2025.
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.
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.
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.
锁骨下动脉狭窄主要由动脉粥样硬化改变引起，这可能导致上肢和中枢神经系统的缺血事件。其他病因包括辐射暴露、血管炎、神经纤维瘤病、外部压迫综合征和纤维肌发育不良。这些患者传统的麻醉挑战是维持脑灌注。
我们报告一例65岁男性患者，因脊柱手术入院，偶然发现左锁骨下动脉狭窄。该患者有外周动脉疾病、糖尿病和重度吸烟史。术前评估时，科室测量的血压读数在正常范围内。在手术室，双臂血压读数显示右臂为136/85 mmHg，左臂为235/114 mmHg。因此，手术推迟，以便进一步评估双臂收缩压差增大的情况。计算机断层血管造影显示左锁骨下动脉起始处局灶性狭窄，导致约90%的狭窄。患者成功接受了锁骨下动脉血管成形术。
报告有外周动脉疾病、重度吸烟或严重代谢综合征病史患者的双臂血压读数很重要。锁骨下动脉狭窄患者容易出现双臂收缩压差增大。因此，双侧血压测量是一项简单的检查，对紧急情况下的麻醉前评估有重要价值。
