Middle aged man presented with signs of left upper limb ischemia. The left radial pulse was feebly palpable. The left upper limb was warm and Doppler (portable) signals are good in the radial and ulnar artery. Left forearm pressure was 90 mm of Hg. Spiral CT angiogram was done to see the aortic arch and subclavian artery. It showed a thrombus the in the proximal past of the subclavian artery ( see Fig ). The thrombus in the subclavian was in contnuity with the thrombus extending in to the thoracic aorta. Two possibilities were discussed by doctors. One is to consider the surgical thrombectomy through the brachial artery and hope that the thoracic part of the thrombus is attached and would not embolize even through we remove subclavian thrombus. We are aware of the fact, if the thrombus in the thrombus get dislodged in the thoracic aorta we do not know where it will be reaching ? It get in to the visceral circulation, renal circulation, pelvic or lower limb circulation and cause an emergency situation. Same is also true with the second option that is thrombolytic therapy. It is not possible to consider filters to trap the thrombus in the thoracic aorta. So, we continued him on medical therapies ( anticoagulants and antiplatelet drugs) and he is attending the followup clinic. His condition improved the pains subsided and limb condition is good. We are planning to repeat investigation after 6 weeks to assess the recanalization.
1) What would you do in this type of cases?
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