3. “Subclavian steal”
refers to a phenomenon of flow reversal in a branch of the subclavian artery that is the
result of an ipsilateral hemodynamically significant lesion of the proximal subclavian
artery
Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med. 1961;265:878–885. 2.
Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med. 2011;16:29–34
5. Clinical Manifestation
brain
Upper
extremity
heart
Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med. 1961;265:878–885.
Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med. 2011;16:29–34.
Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology. 1988;38:669–673.
Schatzl S, Karnik R, Gattermeier M. Coronary subclavian steal syndrome: an extracoronary cause of acute coronary syndrome. Wien Klin Wochenschr. 2013;125:437–438
6. Clinical Manifestation
Brain (vertebrobasilar insufficiency)
Drop attacks
Dizziness
Diplopia
Nystagmus
Hearing loss
Tinnitus
Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med. 1961;265:878–885.
Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology. 1988;38:669–673.
7. Clinical Manifestation
Upper extremity
Arm claudication
Exercise-induced pain and fatique
Coolness and paresthesia
Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology. 1988;38:669–673.
Reivich M, Holling HE, Roberts B, Toole JF. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med. 1961;265:878–885.
8. Clinical Manifestation
Heart
In patients who have undergone CABG using internal mammary arteries
Ipsilateral upper extremity exercise may lead to stolen phenomenon
angina or even infarction
Schatzl S, Karnik R, Gattermeier M. Coronary subclavian steal syndrome: an extracoronary cause of acute coronary syndrome. Wien Klin Wochenschr. 2013;125:437–438
9. Diagnosis
(physical examination)
A discrepancy of >15 mmHg in blood pressure readings taken in both upper
extremities
Pulsus paradoxus or pulsus deficit
Bruit in supraclavicular fossa
Suboccipital bruit
Ipsilateral atrophic skin and nails
Rogers JH, Calhoun RF 2nd. Diagnosis and management of subclavian artery stenosis prior to coronary artery bypass grafting in the current era. J Card Surg. 2007;22:20–25.
Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet.
2012;379:905–914.
Betensky BP, Jaeger JR, Woo EY. Unequal blood pressures: a manifestation of subclavian steal. Am J Med. 2011;124:e1–e2.
Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med. 2011;16:29–34.
Kurien M, Bottomley JR, McGrath EE. Takayasu arteritis. Eur J Cardiothorac Surg. 2011;40:1268.
10. Diagnosis
Continuous wave Doppler and duplex ultrasonography
Transcranial Doppler
CT/MR angiography
Potter, B. J., & Pinto, D. S. (2014). Subclavian steal syndrome.Circulation, 129(22), 2320-2323.
11. Management
Asymptomatic or mild symptomatic patients
Increased cardiovascular risk
Should be treated by medical treatment:
Aspirin,
β-blockade,
Angiotensin converting enzyme inhibition,
Statin
Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Hoffman E, Goto S, Ohman EM, Bhatt DL; REduction of Atherothrombosis for Continued Health Registry Investigators. Adherence to
secondary prevention medications and four-year outcomes in outpatients with atherosclerosis. Am J Med. 2013;126:693–700.e691
13. Summary
SSS is a reversal arterial flow due to proximal subclavian artery stenosis
Mostly asymptomatic
Symptoms my include brain, heart, and upper extremity symptoms
Diagnosis through history and physical examination and supported by ultrasound
or angiography
Treatment options including medications, stenting, and surgery