Anaesthetic Management for Carotid-Subclavian Artery Bypass Surgery for Acute-on-Chronic Upper Limb Ischaemia

Subclavian artery occlusive disease is an uncommon manifestation of peripheral arterial disease that may present with limb-threatening ischaemia requiring urgent revascularisation. We describe the anaesthetic management of a 64-year-old man with acute-on-chronic left upper limb ischaemia undergoing urgent carotid-subclavian bypass in the presence of ischaemic cardiomyopathy and chronic kidney disease. Perioperative management focused on maintaining cerebral and myocardial perfusion through targeted blood pressure augmentation during carotid cross-clamping, judicious fluid administration, and remifentanil-based anaesthesia. The patient recovered without neurological, cardiovascular, or renal complications. This case highlights successful cerebral and myocardial protection during prolonged carotid cross-clamping in a patient with significant comorbidities, using pragmatic haemodynamic strategies in a resource-limited setting.