Arteria lusoria dissection with mediastinal hematoma as a complication of a transradial coronary catheterization. Case report and literature review

INTRODUCTION: Aberrant right subclavian artery (ARSA), or arteria lusoria is the most common embro-logic anomaly of the aortic arch. It is generally asymptomatic and incidentally diagnosed during aradiological exam or procedure.PRESENTATION OF CASE: Here, we report a case of ARSA incidentally diagnosed and injured (dissectionwith mediastinal hematoma) during a right transradial coronary angiography in a 83 years old femalepatient. The patient underwent prompt hybrid procedure with the isolation of the right humeral artery from where we positioned a GORE®VIABAHN®9 × 100 mm endoprosthesis. The procedure was successfulwith optimal results at early and long term follow up.DISCUSSION: Sometimes, a dissection of the ARSA may occur, especially for excessive manipulation duringendovascular procedures, and when such complication happens it should be promptly treated as it canbe life-threatening.CONCLUSION: If transradial catheterization during coronary angiography becomes particularly difficult,requires longer time, or the guide wire enters in the descending aorta, particularly attention should bepaid, as dreadful complications such as dissection or lesion may happen and prompt treatment is required.