Bilateral subclavian artery stenosis found by inter-arm blood pressure difference during distal pancreatectomy

Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04), and an echocardiogram revealed a reduction in ejection fraction (37% from 50%). Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient’s central blood pressure was 70–80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery.

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Subclavian artery stenosis and blood pressure control

Anaesthesia ◽

10.1111/j.1365-2044.2006.04600.x ◽

2006 ◽

Vol 61 (4) ◽

pp. 409-410 ◽

Cited By ~ 5

Author(s):

R. J. Wood ◽

A. J. Walmsley

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Subclavian Artery ◽

Pressure Control ◽

Artery Stenosis ◽

Subclavian Artery Stenosis

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A case of recurrent pancreatitis with subclavain artery stenosis: a clinical dilemma (unrelated co-existence or IgG4 related disease?) and a clinical lesson

International Surgery Journal ◽

10.18203/2349-2902.isj20210981 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1321

Author(s):

Vijayalakshmi Sunder ◽

Shanthi Ponandal Swaminathan ◽

Vikas Kawarat ◽

Kannan Ross

Keyword(s):

Blood Pressure ◽

Acute Pancreatitis ◽

Subclavian Artery ◽

Vascular System ◽

Artery Stenosis ◽

Lower Limbs ◽

Subclavian Artery Stenosis ◽

Related Disease ◽

Igg4 Related Disease ◽

Clinical Dilemma

We report a case of a 56-year-old woman who presented with clinical features suggestive of acute pancreatitis. She had a similar episode 5 years ago. A blood pressure (BP) recording of 80/50 mmHg in the presence of acute pancreatitis led to the diagnosis of circulatory shock and vasopressors were about to be commenced. However, her overall appearance was stable and measurement of BP in the lower limbs was normal. An angiogram revealed left subclavian artery stenosis which explained the low BP reading on left arm. The patient responded to conservative management of pancreatitis, however refused further evaluation of subclavian stenosis. This case is being reported to highlight a clinical dilemma and a clinical lesson. Dilemma arises if the pancreatitis and subclavian artery stenosis is just a coincidental occurrence or it is a case of IgG4 related disease consisting of autoimmune pancreatitis (AIP) type 1 with subclavian artery stenosis a part of extra-pancreatic manifestation of the IgG4 related disease spectrum. This distinction is important in management of pancreatitis and other organ involvement. It is important to examine a patient fully and especially the vascular system - wherein all pulses are to be felt and blood pressure recorded in both sides and both limbs - whenever there is a conflict between the condition/appearance of the patient and the signs that we elicit. In this case recognising that BP was normal in the lower limbs prevented unnecessary use of vasopressors.

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INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE IS ASSOCIATED WITH A HIGH PREVALENCE OF CARDIO VASCULAR DISEASES- A CROSS-SECTIONAL STUDY IN POLICE WORKER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1524 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Somesh Raju ◽

Rina Kumari ◽

Sunita Tiwari ◽

NS Verma

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blood Sugar ◽

Pressure Difference ◽

Systolic Pressure ◽

Working Environment ◽

Vascular Events ◽

Cross Sectional ◽

Blood Pressure Difference ◽

High Prevalence

Background: Interarm systolic blood pressure difference more than 10 mm of Hg is predictor of cardiovascular and metabolic risk. Despite of sufficient physical activity there is high prevalence of obesity in police personal because of stressful working environment. No studies have addressed the significance of interarm pressure difference among them. Therefore, the present study conducted to access the relation of interarm blood pressure difference with obesity in police personnel. Aims and Objective: To estimate the interarm pressure difference in police personal to see its association with their obesity. Material and Method: This cross-sectional observational study done on 245 police workers in PAC, Sitapur, India. Subjects having more than ten years of working experience were included in study. Anthropometric measurements of subject recorded by following standard protocol. Measurement of systolic pressure in both arm recorded simultaneously by mercury sphygmomanometer. Available data analyze and expressed in percentage, mean with SD and chi square test to see the significance of association. Results: According to anthropometric results of subjects 77.14 prcent subjects were having generalised obesity and 82.04 percent of subjects having abdominal obesity. 34.29 percent of subjects showed abnormally high (?10 mmHg) inter-arm systolic blood pressure difference. Both type of obesity showed positive association with blood sugar level but no association with interarm pressure difference. Conclusion: Interarm blood pressure difference is greater in individual having obesity or prolong duration of service. Such subjects are more susceptible to develop coronary artery disease or peripheral arterial disease in future. Early screening can help to detect the vascular events likely to occur in the future Keywords: Body mass index, Waist circumference, Interarm pressure difference, Random blood sugar

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