肝素治療急性左鎖骨動脈血栓併左上肢缺血之病例報告

Acute Subclavian Artery Thromboembolism with Upper Limb's Ischemia Successfully Treated with Unfractionated Heparin: A Case Report

急性鎖骨動脈阻塞是一少見臨床疾病，若不及時治療並恢復血流將會造成永久肢體傷害。受損前臂動脈脈搏消失、疼痛、肢體蒼白、肢體麻木及肢體無力是急性鎖骨動脈阻塞之臨床特徵。一名六十歲女性，患有類風濕性二尖瓣膜狹窄併慢性心房顫動，因突然左手疼痛、蒼白、麻木及肢體無力至本院就診：經緊急血管攝影檢查證實為急性鎖骨動脈阻塞；因病灶之血栓佔了80%脊椎動脈口，故僅施行靜脈肝素注射，治療後左手症狀明顯改善；72小時後，血管再攝影發現左鎖骨動脈血栓完全消失。本篇病例報告對急性鎖骨動脈阻塞之發生機轉、原因、診斷及治療作討論及分析。

Acute subclavian artery occlusion is a rare clinical entity, with potential catastrophic consequences if not treated immediately. Permanent limb loss may result due to inadequate blood flow to the affected extremity. Brachial arterial pulse deficit, pain, paresthesia, arm fatigue and pallor of the affected limb are hallmark of acute subclavian arterial occlusion. A 60 years old female patient with a past history of rheumatic mitral stenosis in permanent atrial fibrillation came to our OPD with complaints of a sudden onset of left arm pain, weakness, numbness and pallor after she did strenuous work in the yard 3 days earlier, which required continuous flexion and adduction of the arms. Immediate angiography showed a thrombotic lesion occluding the left subclavian and vertebral arteries. Intravenous unfractionated heparin was initiated, the left arm's perfusion improved and, pulsation in the brachial, ulnar and radial arteries was restored. Follow-up angiography 72 hours later showed complete resolution of the left subclavian arterial thrombus. There was complete recovery of the strength, sensation and pulsation of the left upper extremity.