•Mostafa, Nasir, Smith

Title:

Body:

This case report presents a vasculopathic patient who underwent a left carotid endarterectomy for severe asymptomatic carotid artery stenosis. The patient's history includes right breast cancer recurrence treated with radical mastectomy resulting in right-arm lymphedema. Due to anecdotal precautions, right arm blood pressure cuff measurements were prohibited. Undetected severe stenosis in the left subclavian artery resulted in inaccurately low blood pressure measurements, influencing hypertension management and contributing to subsequent complications during the postoperative phase. This case underscores the significance of identifying subclavian stenosis as a potential confounder in blood pressure assessment and emphasizes the need for alternative measurement techniques for optimal hypertension management in similar patients.

Relevant history:

HTN DM CAD R breast IDC s/p lumpectomy and subsequent radical mastectomy for recurrence with postoperative chemotherapy.

Relevant test results:

Carotid U/S demonstrating LICA stenosis >90%. CTA demonstrating severe LSCA stenosis. ECHO with normal EF. Negative chemical cardiac stress test.

Teaching points:

The patient underwent successful LCEA with an extended hospital stay to adjust anti-hypertensive medication due to outpatient under-treatment caused by erroneous lower blood pressure measurements on the left arm due to severe left subclavian stenosis. Prompt identification and management may prevent the inappropriate and unnecessary use of vasopressor/vasodilator medications, and avoid the adverse effects of uncontrolled hypertension and the complications often associated with prolonged hospitalization.