In a rare and complex vascular case, a team of doctors at the district Wenlock Hospital in Mangaluru successfully performed a combined surgical revascularisation procedure on an elderly woman suffering from simultaneous occlusion of major arteries supplying the head, neck, and left upper limb.
Patient Condition and Diagnosis
The patient, in her 60s, presented with persistent giddiness and pain in her left hand, along with early signs of gangrene. Detailed evaluation revealed occlusion of the left common carotid artery and the proximal segment of the left subclavian artery. This uncommon combination significantly affected blood flow to the brain and upper extremity, posing a high risk of stroke and limb loss.
Surgical Approach
After thorough assessment, the surgical team proceeded with a dual approach. They performed a left carotid endarterectomy to remove the atherosclerotic plaque, along with a bypass from the common carotid artery to the left subclavian artery using a prosthetic vascular graft. This restored adequate perfusion to both the left upper limb and the vertebral arterial circulation.
Medical Team
The procedure was carried out by Dr. Suresh Pai and Dr. Suraj Pai from the Department of Cardiovascular and Thoracic Surgery at KMC Mangalore.
Expert Insights
Speaking about the case, Dr. Suraj Pai said: “Surgical revascularisation is reserved for long-segment arterial occlusions, commonly involving the lower limbs. Carotid arterial disease along with subclavian arterial disease is an uncommon entity requiring thorough planning of surgical approach and preparation of patient.” He further added that careful intraoperative strategy and coordinated team planning were crucial in achieving a stable outcome in this high-risk case. The combined approach ensured restoration of both cerebral and upper limb circulation without complications.
Outcome
Postoperatively, the patient showed significant symptomatic relief and regained full functionality of the left upper limb. The successful outcome highlights the importance of multidisciplinary planning and advanced surgical techniques in managing rare vascular conditions.
