Kinked Innominate Artery – A Rare Cause for Upper Limb Ischemia

Abstract

Abstract Interventions of the aortic arch can lead to unexpected complication of atheroembolization from the plaques with many cases of CVA following TEVAR being reported in the literature. It is especially seen in old diabetic patients. Embolizations is a known entity in cases of loop Common carotid vessels. The abnormal curvature causes stasis of blood leading onto development of thrombus. Diseases related to Innominate artery are very rare. Kinking of Innominate artery is even rarer abnormality and very few cases only have been reported in the literature. The various clinical scenarios of kinked innominate artery reported are presence of pulsatile mass in the neck, In CXR the kinked artery masquerading as right upper lobe lung mass. Herein we report a case of Right upper limb little finger gangrene following coronary angiogram. On CT Angio evaluation it was found that there was thrombus in distal innominate and subclavian vessels with kinking of Innominate, Left Common carotid and Left Subclavian also. The passage of hardwares across the kinked innominate artery had caused the thrombus formation and subsequent embolization. This is the 1st case in literature to report the kinked innominate artery has caused a procedural complication. We report this case to inform that extreme caution should be undertaken during interventional procedures in cases of abnormal curvatures of great vessels to avoid complication.