September 24, 2015

Case Study:   A 53yr old woman is referred for palpitations, subclavian steal syndrome, and weakness and tingling in her left arm.  She additionally complains of severe post prandial abdominal pains that result in nausea and vomiting.  In recent months, she has developed an avoidance of food leading to a loss of 35lbs.  Despite a GI work-up and CT, no clear cause had yet been identified. The patient was emotionally distressed when discussing the lack of results from so many of the previous tests.

Dr. Brian Kelly, DO, recommended a cardiac work-up with echo and cardiac stress test.  Additionally an invasive catheterization was ordered to assess the left subclavian artery and the abdominal aorta to identify any vascular cause of her abdominal angina.  Dr. Pradip Jamnadas, MD, performed the catheterization in the CVI cath lab 2 days later where she was discovered to have a long total occlusion of the left subclavian artery and a significant high grade lesion in the celiac artery (pictured below left).  Dr. Jamnadas placed a Medtronic bare metal stent in the celiac artery (below right) without complication and successfully restored blood flow.  The patient was recovered for 2.5 hours and discharged home without complication.

celiac stenosis

Remarkably, we brought lunch in for her and her spouse during recovery and allowed her to eat while under observation.  She had previously had symptoms within 10 minutes of eating.  That mark came and went and soon
stent subclav
30 minutes had turned into 90 and still no symptoms.  Now that is called a CVI Happy Meal!  The patient was discharged and seen the next day in our office after having dinner that night and breakfast in the morning without symptoms.  She will continue with scheduled cardiac testing and intervention of the left subclavian artery in two weeks.  This is another example of the extraordinary medicine delivered at Cardiovascular Interventions by Dr. Pradip Jamnadas, MD and Dr. Brian Kelly, DO.

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