Ulcerations

Definition

• An ulceration is a break in the intimal covering of a plaque that exposes the media and the atheromatous core of the lesion to the bloodstream.

• Ulcerations of the subclavian artery are a potential embolic source.

Fig. 3.1.2 Female, 46 years old, pain left upper extremity and vertigo after slight exertion, history of renal transplantation, occluded AV fistula in left arm with occlusion of radial artery, CT angiography (1) and DSA (2): sub-occlusion of a highly calcified left prevertebral subclavian artery, demonstration of a subcla-vian steal (3)

Fig. 3.1.2 Female, 46 years old, pain left upper extremity and vertigo after slight exertion, history of renal transplantation, occluded AV fistula in left arm with occlusion of radial artery, CT angiography (1) and DSA (2): sub-occlusion of a highly calcified left prevertebral subclavian artery, demonstration of a subcla-vian steal (3)

Fig. 3.1.3 Left subclavian-to-carotid transposition (1), protection of vagus and phrenic nerve. Postoperative CT angiogram (2) showing a patent end-to-side anastomosis and a patent VA
Fig. 3.1.4 Male, 69 years old, dysphagia lusoria, left retroesophageal subclavian artery with compression of the oesophagus. CT scan (1), opacification of oesophagus (2)

Fig. 3.1.5 Female, 60 years old, stenosis of a right retroesophageal subclavian artery with floating thrombus, common carotid trunk, right VA originating from right common carotid artery (CCA)

Fig. 3.1.6 Tip necrosis of right index finger, embolic occlusion
Fig. 3.1.7 Carotid-subclavian by-pass, protection of phrenic nerve, postoperative MR angiogram

Symptoms

• Their presentation is more frequently subacute or chronic than acute.

Diagnosis/Investigations

• The pulsed Doppler is the preferred diagnostic test.

• Arteriography confirms the lesion and demonstrates any downstream lesions.

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