Dissection of Arteria Lusoria during Transradial PCI: A Rare Complication revealed and followed by Multidetector CT
DOI:
https://doi.org/10.12970/2311-052X.2013.01.02.1Keywords:
Aberrant right subclavian artery, arteria lusoria, complication, dissection, transradial catheterization.Abstract
Though the radial artery is an ideal site of access for coronary percutaneous interventions (PCI), anatomical variations may render this procedure more challenging. An aberrant right subclavian artery (arteria lusoria) arising from the descending aorta is an uncommon congenital variant that occurs in about 0.2–1.7% of the population. In such cases, the angulated retroesophageal course of this artery to the descending aorta imposes difficulties in advancing a guide wire to the ascending aorta during right transradial catheterization. Performing angioplasty by the same way becomes also a difficult task, and requires greater perseverance and skills. We present a report of a iatrogenic dissection of the arteria lusoria during right transradial coronary percutaneous intervention evaluated and confirmed by multidetector computed tomography. This imaging modality is useful to assess the severity and extension of the dissection in order to guide the clinical management of this complication.
References
Ludman PF, Stephens NG, Harcombe A, et al. Radial versus femoral approach for diagnostic coronary angiography instable angina pectoris. Am J Cardiol 1997; 79: 1239-41. http://dx.doi.org/10.1016/S0002-9149(97)00089-1
Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol 1998; 32: 572-6. http://dx.doi.org/10.1016/S0735-1097(98)00288-5
Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol 1997; 29: 1269-75. http://dx.doi.org/10.1016/S0735-1097(97)00064-8
Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures. Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004; 44: 349-56. http://dx.doi.org/10.1016/j.jacc.2004.04.034
Valsecchi O, Vassileva A, Musumeci G, et al. Failure of transradial approach during coronary interventions: anatomic considerations. Catheter Cardiovasc Interv 2006; 67: 870-8. http://dx.doi.org/10.1002/ccd.20732
Huang L, Hwang H-R, Li S-C, et al. Dissection of arteria lusoria by transradial coronary catheterization: a rare complication evaluated by multidetector CT. J Chin Med Assoc 2009; 72.
Janssen M, Baggen MG, Veen HF, et al. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol 2000; 95: 1411-6. http://dx.doi.org/10.1111/j.1572-0241.2000.02071.x
Brown DL, Chapman WC, Edwards WH, Coltharp WH, Stoney WS. Dysphagia lusoria: aberrant right subclavian artery with a Kommerell’s diverticulum. Am Surg 1993; 59: 582-6.
Abhaichand RK, Louvard Y, Gobeil JF, Loubeyre C, Lefevre T, Morice MC. The problem of arteria lusoria in right transradial coronary angiography and angioplasty. Catheter Cardiovasc Interv 2001; 54: 196-201. http://dx.doi.org/10.1002/ccd.1266
Trigaux JP, Schoevaerdts JC, van Beers B, Berben JY. Pitfalls of digital angiography in the diagnosis of right aortic arch. Eur J Radiol 1987; 7: 216-9.
Kwok PC, Ho KK, Tse CW, Siu KW, Tsao JP, Cheung JY. Role of multidetector computed tomography in stent-graft repair of type B aortic dissection in a patient with an aberrant right subclavian artery. J Endovasc Ther 2005; 12: 621-3. http://dx.doi.org/10.1583/05-1608.1
Ka-Tak W, Lam WWM, Yu SCH. MDCT of an aberrant right subclavian artery and of bilateral vertebral arteries with anomalous origins. Am J Roentgenol 2007; 188: W274-5. http://dx.doi.org/10.2214/AJR.05.0694
