The Missing Pulse: Incidental Right Subclavian Artery Stenosis Identified in Pre Anaesthetic Assessment: A Case Report

Subclavian artery stenosis is an uncommon but clinically significant condition, often undetected until perioperative evaluation reveals inter-arm blood pressure discrepancies. We report a 50-year-old male scheduled for laparoscopic nephrectomy, in whom absent right radial pulse and decrease right-arm blood pressure (110/70 mm of Hg on right and 150/80 mm on Hg left) led to the diagnosis of near-total right subclavian artery occlusion with partial left-sided stenosis. The patient, a chronic smoker, had no neurological or ischemic symptoms. Perioperative management focused on maintaining hemodynamic stability using blood pressure monitoring from the unaffected arm and pulse oximetry for perfusion assessment. Surgery proceeded uneventfully without perfusion-related complications. This case emphasizes the importance of bilateral pulse palpation and blood pressure measurement during pre-anaesthetic evaluation, especially in patients with vascular risk factors. Early recognition prevents misinterpretation of systemic blood pressure and ensures appropriate intraoperative management, thereby avoiding potential cerebrovascular and cardiac complications.