Uncommon Presentation of Recurrent Lung Adenocarcinoma: A Finger Ulcer Induced by Subclavian Artery Invasion Successfully Healed With Viabahn VBX Treatment

Abstract

Recurrence of a lung tumor invading the subclavian artery, causing stenosis and leading to finger ulcers as the initial symptom, is rare. We employed endovascular techniques, inserting a Viabahn® VBX covered stent (W. L. Gore & Associates, Flagstaff, Arizona) to aid in ulcer healing and improve the patient's quality of life. The patient, a 73-year-old male, had a history of lung adenocarcinoma resection two years prior but had not undergone follow-up examinations or cancer-specific treatments. Clinical examination revealed an invasion of the right subclavian artery by the recurrent tumor, resulting in severe stenosis and ischemic symptoms in the right upper limb. Given the patient's advanced cancer stage and the decline of further tumor-specific treatments, an endovascular intervention using a Viabahn VBX covered stent was performed to improve blood flow and promote ulcer healing. The stent demonstrated exceptional stability and patency during the six-month follow-up, greatly improving the patient's quality of life. This case highlights the importance of recognizing atypical symptoms as potential indicators of tumor recurrence or progression and demonstrates the promising role of covered stents in managing vascular complications in selected patients with advanced-stage malignancies.

Keywords: covered stent; endovascular intervention; lung adenocarcinoma; recurrence; vascular invasion.

Figure 1. Radiological manifestations and clinical presentations of hand ischemia induced by right subclavian artery stenosis caused by malignant lung tumor.

(A) Clinical signs of severe ischemia in the right upper limb: atrophy of the deltoid muscle and a right little finger ulcer. (B and C) Axial and sagittal views showing the malignant tumor encircling the right subclavian artery. (D and E) The proximal segment of the right subclavian artery stenosis observed in the coronal view. (F) The distal segment of the right subclavian artery stenosis observed in the coronal view. The yellow arrow indicates the lesion.

Figure 2. Endovascular procedure of covered stent implantation in the right subclavian artery.

(A) Angiography confirms a lesion at the origin of the right subclavian artery, with the right vertebral artery not clearly visualized. (B) Balloon angioplasty (5 mm × 80 mm) predilates the lesion. (C) Viabahn VBX covered stent (7 mm × 79 mm) released using a balloon expansion technique. (D) Post-dilation (6 mm×40 mm balloon) ensures proper stent conformity in proximal and distal segments with the vessel wall. (E) The stent exhibits optimal conformation. (F) Improved blood flow to the upper limb observed after stent implantation.

Figure 3. Six-month follow-up results.

(A and B) Ultrasonography of the right subclavian artery demonstrates a well-formed intravascular stent (A) with unobstructed blood flow inside the stent (B). (C) Clinical manifestations of the right upper limb following endovascular treatment: erythematous skin color and complete healing of the ulcer on the right little finger.