Superficial Temporal Artery Access for Angiography in a Patient With Leriche Syndrome, Subclavian Artery Occlusions, Multiple Acute Arterial Thromboses, and Heart Failure

Despite significant progress in revascularization techniques, the vascular approach itself can still be a challenge in complex polyvascular disease. In this case report, we describe the feasibility of a potentially underutilized alternative vascular approach in a patient with multiple arterial occlusions who presented to our hospital with acute multivessel thromboses and chronic occlusions of the distal aorta and subclavian arteries, which rendered noninvasive blood pressure measurements unreliable. The patient also exhibited signs of heart failure with a severely reduced ejection fraction, likely due to ongoing ischemia, as the ventricles had not yet remodeled. To overcome the anatomical limitations safely, we used superficial temporal artery access for coronary angiography – an approach first described, to the best of our knowledge, by Csavajda et al. In addition, this access enabled angiography of the aorta and its branches, visualization of collateral flow, and invasive intra-aortic blood pressure measurement. Together with the possibility to better titrate medical therapy, this additional diagnostic information allowed us to plan aortocoronary bypass surgery with appropriate graft selection and ultimately contributed to improved patient outcomes.