Digital Embolization Due to Partially Uncovered Left Subclavian Artery Post TEVAR: Management with Amplatzer Vascular Plug Occlusion

Abstract

Purpose: To describe the use of the Amplatzer vascular plug to treat a partially uncovered left subclavian artery (LSA) causing digital embolism following thoracic endovascular aneurysm repair. Case Report: A 70-year-old man presented with digital ischemia of the left index and middle fingers due to embolism from a partially covered LSA orifice during thoracic endovascular aneurysm repair for a type I thoracic aortic aneurysm. The orifice was successfully occluded using the vascular plug, supplemented by a left carotid-subclavian bypass to treat ongoing arm and hand claudication. The patient has had no further embolic episodes. Conclusion: A partially uncovered LSA during thoracic endovascular aneurysm repair poses a risk of thromboembolism, with resultant upper limb claudication or tissue loss. If recognized at the time of the procedure, this should be treated by proximal extension; otherwise, proximal LSA occlusion using an Amplatzer occluder may be a safe and effective option in preventing further embolic episodes.