Apr 09, 2019 an invariable finding in patients with symptoms of subclavian steal syndrome is a difference in upperextremity pulses and brachial systolic blood pressures between the patients arms. Subclavian steal syndrome is a rare condition causing syncope or neurological deficits when the blood supply to the affected arm is increased through exercise. Sss is an interesting presentation intertwined within a number of other pathologies that can muddy the water. The term subclavian steal describes retrograde blood flow in the vertebral artery associated with proximal ipsilateral subclavian artery stenosis or occlusion, usually in the setting of subclavian artery occlusion or stenosis proximal to the origin of the vertebral artery. Both patients showedan interesting response to hyperventilation. This blockage results in a lack of blood reaching the ipsilateral arm through the subclavian artery, which can lead to a reversal of blood flow in the affected. Dissection, takayasu p i c t o r i a l subclavian steal syndrome m e d i c i n e arteritis, and external compression on the subclavian artery are rare causes. Any information contained in this pdf file is automatically generated from digital material. Subclavian steal syndrome with or without arterial stenosis. Ultrasound with pulsed doppler spectral analysis can demonstrate patency and flow direction in the vertebral artery and can establish the presence of subclavian steal. With subclavian steal syndrome, if neurologic symptoms do occur, they tend to be transient eg, hypoperfusive transient ischemic attack and seldom lead to stroke.
The newly characterized subclavian steal syndrome represents a unique complication of cerebral arterial occlusive disease. Subclavian steal syndrome from the ipsilateral vertebral artery. Steal syndromestrategies to preserve vascular access and. Subclavian steal syndrome sss, also called subclavian steal phenomenon or subclavian steal stenoocclusive disease, is a constellation of signs and symptoms that arise from retrograde reversed blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis narrowing andor occlusion of the subclavian artery. Subclavian steal syndrome sss is caused by a hemodynamically critical proximal subclavian artery stenosis or occlusion with subsequent retrograde filling of. Management of the subclavian steal syndrome comment this patient showed no hypertension and no arm claudication, nor were any other symptoms provoked by arm exercise. Thompson summary anaesthesia in two patients with subclavian stealsyndrome is described.
In most cases, subclavian steal is asymptomatic ie, subclavian steal phenomenon, does not warrant invasive evaluation or treatment, and. The blockage or narrowing is usually caused by plaques from atherosclerosis. Overview 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. Subclavian steal occurs when a subclavian artery stenosis proximal to the vertebral origin causes retrograde flow in the ipsilateral va. Subclavian steal syndrome by marta thorup definition subclavian steal syndrome sss, is a constellation of signs and symptoms that arise from retrograde flow of blood in the vertebral artery, due to proximal stenosis or occlusion of the subclavian artery. Full text is available as a scanned copy of the original print version. An invariable finding in patients with symptoms of subclavian steal syndrome is a difference in upperextremity pulses and brachial systolic blood pressures between the patients arms. Less common causes of occlusion include dissecting aortic arch aneurysm, embolus, and takayasus arteritis. In nephrology, vascular access steal syndrome is a syndrome caused by ischemia not enough blood flow resulting from a vascular access device such as an arteriovenous fistula or synthetic vascular graftav fistula that was installed to provide access for the inflow and outflow of blood during hemodialysis. Subclavian steal syndrome presentation and treatment. Links to pubmed are also available for selected references. The nitrous oxide method for the quantitative determination of cerebral blood flow in man.
There is an increased incidence with age and the greater male predilection with a m. Subclavian steal phenomenon refers to stenoocclusive disease of the proximal subclavian artery with retrograde flow in the ipsilateral vertebral artery subclavian steal syndrome is the same as subclavian steal phenomenon with the addition of cerebral ischemic symptoms epidemiology. Subclavian steal phenomenon is a function of the proximal subclavian artery sa stenoocclusive disease, with subsequent retrograde blood flow in the ipsilateral vertebral artery va. Subclavian steal syndrome sss is a relatively rare vascular abnormality that could be challenging to diagnose. The subclavian steal syndrome the annals of thoracic surgery. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Symptoms of sss include vertigo during arm exertion and hand or arm pain. Subclavian steal syndrome is an abnormal blood flow resulting in a significant reduction in blood supply to the brain, neck, and arms resulting from reversal of blood flow through the blood vessel that supplies the brain vertebral artery due to occlusion or narrowing of the blood vessels. Subclavian steal syndrome definition of subclavian steal. Subclavian steal syndrome causes, symptoms, diagnosis. Source for information on subclavian steal syndrome. Evaluation of coronary subclavian steal syndrome using sestamibi.
This blockage results in a lack of blood reaching the ipsilateral arm through the subclavian artery, which can lead to a reversal of blood flow in the affected vertebral artery so that blood from the contralateral. The underlying pathophysiology of subclavian steal syndrome is the development of a negative pressure. Subclavian steal syndrome can become manifest in some patients with symptoms of arterial insufficiency afflicting the brain, 1 3 the upper extremity, 2 or even the heart if part of the coronary circulation is supplied via an ima graft, 4 as was the case in this patient. Oct 18, 2014 in medicine, subclavian steal syndrome sss, also called subclavian steal phenomenon or subclavian steal stenoocclusive disease, is a constellation of signs and symptoms that arise from. Latent subclavian steal syndrome was detected in 26. The full text of this article is available as a pdf 84k. Although color doppler sonography is a safe diagnostic method in cases with partial steal or in received july 17, 2003. Subclavian steal syndrome subclavian steal phenomenon, subclavian steal stenoocclusive disease is a vascular syndrome caused by an occlusion in the subclavian artery proximal to the origin of the vertebral artery, resulting in retrograde flow of blood. What are the treatment options for subclavian steal syndrome. Subclavian steal syndrome, or sss, is a syndrome caused by a blockage or narrowing in the subclavian artery. Subclavian steal syndrome subclavian steal syndrome and subclavian steal phenomenon both result from severe proximal subclavian artery stenosis or occlusion resulting in re. When the flow reversal affects an organ to the degree that symptoms for example headache, dizziness, or anginal chest pain develop, the patient may be defined as having the subclavian steal syndrome.
Subclavian steal syndrome knowledge for medical students. Anatomical basis of subclavian steal syndrome explained. What is the prognosis of for subclavian steal syndrome. In accessrelated steal syndrome, four stages can be distinguished table 1. Coronary steal phenomenon cardiac steal syndrome general cardiology dr jamal usmle duration. Dec 07, 2017 coronary steal phenomenon cardiac steal syndrome general cardiology dr jamal usmle duration. Subclavian steal is secondary to a proximal stenosing lesion or occlusion in the subclavian artery, typically on the left. Subclavian steal syndrome definition, symptoms, treatment. In order to compensate for the increased oxygen demand in the arm, blood is drawn from the. Subclavian steal syndrome causes sss is a consequence of a redundancy in the circulation of the brain and the flow of blood. Atherosclerotic vascular disease is the most common cause of both the subclavian steal phenomenon as well as the syndrome 17,18. Jul 22, 2014 associated steal syndromes coronary subclavian steal syndrome.
If the affected arm is exer cised, the increased blood flow required is provided by retrograde flow in the ipsilateral ver. A case report of coronarysubclavian steal syndrome treated. The subclavian steal syndrome occurs when there is a block in a subclavian artery between its origin at the aorta and the origin of the ipsilateral ver tebral artery fig. Subclavian steal syndrome teachmesurgeryteachmesurgery. Subclavian steal syndrome refers to stenoocclusive disease of the proximal subclavian artery with retrograde flow in ipsilateral vertebral artery and associated cerebral ischaemic symptoms.
Parrott, md, minneapolis the subclavian steal is a retrograde flow of blood from the vertebralbasilar sys tem into the subclavian artery. The subclavian arteries are the large arteries which originate from the aorta near the base of the neck and travel under the collar bones to carry blood to each arm. Alternatively, innominate artery disease has also been associated with. Subclavian steal syndrome 5minute clinical consult. Subclavian steal syndrome is treated using the same methods utilized in other forms of peripheral artery disease, including lifestyle changes, angioplasty and stenting, surgical bypass, and medications. Therefore, with a simple physical examination, the clinician can effectively eliminate significant subclavian arterial lesions without the need for angiography.
View full size version of subclavian steal syndrome. The left subclavian artery is the aortic arch branch vessel most commonly affected by atherosclerosis. Complete understanding of the hemodynamics of sss, proper sonographic scanning technique, and knowledge of the clinical presentation of the syndrome are the key factors for a successful examination. Vertebral artery doppler waveform changes indicating subclavian steal physiology mark a. The following case study was a patient that presented in clinic in the year in which i considered subclavian steal syndrome sss within my differential diagnosis. The true prevalence of subclavian artery occlusive disease and subclavian steal syndrome is unknown. Subclavian steal syndrome is a constellation of signs and symptoms that arise from retrograde blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis andor occlusion of the subclavian artery. The phenomenon of coronarysubclavian steal is defined as the reversed blood flow in a coronary artery, through internal mammary artery graft towards. Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition.
The subclavian steal syndrome is a condition that results from the stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery. Subclavian steal syndrome an overview sciencedirect topics. In patients with inadequate cerebral collateral supply, they can develop posterior circulation symptoms and then this condition is called subclavian steal syndrome. The subclavian steal syndrome is a condition that results from the stenosis or occlusion of the. Information and translations of subclavian steal syndrome in the most comprehensive dictionary definitions resource on the web. Jul 19, 20 subclavian steal syndrome causes sss is a consequence of a redundancy in the circulation of the brain and the flow of blood.
Subclavian steal syndrome is caused by occlusion of the proximal subclavian artery. Percutaneous angioplasty and stenting of left subclavian artery lesions for the treatment of patients with concomitant vertebral and coronary subclavian steal syndrome. Carotidsubclavian bypass for subclavian steal syndrome. Innominate steal syndromea hybrid approach medcrave. Anatomical basis of subclavian steal syndrome youtube. Showing records 1 3 of 3 carotid subclavian bypass to correct subclavian steal syndrome illustration. Subclavian steal syndrome circulation aha journals. The arterial crosssection was calculated with the us equipment using the formula am2 rd2, du.
Apr 09, 2019 with subclavian steal syndrome, if neurologic symptoms do occur, they tend to be transient eg, hypoperfusive transient ischemic attack and seldom lead to stroke. The blockage causes the reversal of the normal direction of blood flow in the vertebral artery which is termed the steal, because it steals blood from the cerebral circulation. The subclavian steal syndrome is a rare but important cause of syncope. Subclavian steal syndrome implies the presence of significant symptoms due to arterial insufficiency in the brain ie, vertebrobasilar insufficiency or upper extremity, which is supplied by the subclavian artery. The symptoms from the compromised vertebrobasilar and brachial blood flows constitute the subclavian steal syndrome sss, and include paroxysmal vertigo.
Subclavian steal syndrome is a rare condition and is only recognized as an incidental finding during the sonography procedure of the vertebral system. Sharma vk, chuah b, teoh hl, chan bp, sinha ak, robless pa. Radiol 1976 27, 483488 the subclavian steal syndrome s. Dec 26, 2015 sonography is the initial imaging examination when subclavian steal syndrome is suspected. This rare complication of cardiac revascularisation leads to recurrence of myocardial ischaemia. The mechanism of this response and its implications for the anaesthetist are discussed. Subclavian steal syndrome clinical maze clinical maze. He underwent left carotid to subclavian bypass with relief of symptoms. Dr jamals usmle notes and match guide 5,031 views 3. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the.
Subclavian steal phenomenon is associated with specific vertebral artery waveforms. In most cases, subclavian steal is asymptomatic ie, subclavian steal phenomenon, does not warrant invasive evaluation or treatment, and represents an appropriate physiological. Subclavian steal syndrome sss is a condition in which the subclavian artery proximal to the origin of the vertebral artery narrows or becomes occluded, usually due to atherosclerosis. Subclavian steal syndrome is a form of peripheral artery disease, which is any condition where arteries outside of the heart become narrowed. Ss syndrome is the association of stenoticoccclusive disease of the sca and cerebrovascular episodes 1, 2. The decreased blood flow to the posterior brain and upper extremity may cause lightheadedness, dizziness, ataxia, vertigo, visual. Subclavian steal syndrome as the presenting feature bioline. Chronic brainstem ischemia in subclavian steal syndrome. Definition of subclavian steal syndrome in the dictionary. Subclavian steal syndrome is a condition in which the subclavian artery proximal to the origin of the vertebral artery narrows or becomes occluded, usually due to atherosclerosis. When feasible, subclavian angioplasty andor stent placement can provide acceptable result for. Subclavian steal syndrome brachial basilar insufficiency.
Subclavian steal syndrome patient education clearinghouse. Subclavian steal syndrome radiology reference article. Subclavian steal syndrome, although rare, should be considered in the differential diagnosis in patients with the history of subclavian artery manipulation in the past in proper settings. Subclavian stenosis causes stealing of coronary blood flow via the arterial anastomosis, causing angina. The vertebral arteries participate in the collateral circula tion around the first portion of the sub clavian artery. Subclavian steal phenomenon occurs where there is a highgrade stenosis at the first part of the subclavian artery, with reversal of flow in the ipsilateral vertebral artery. This syndrome occurs when the first portion of the subclavian artery is occluded. The subclavian steal syndrome sss refers to a vascular disorder in which occlusion or stenosis of the subclavian artery proximal to the vertebral artery origin which is the subclavian artery causes altered vascular haemodynamics that result in retrograde blood flow in the ipsilateral vertebral artery toward the upper arm, distal to the subclavian artery narrowing, where. Subclavian steal syndrome causes, symptoms, diagnosis and. In this condition, obstruction of the proximal subclavian artery can be shown by arteriography to cause an actual egress of blood from the basilar arterial system through a reversal of flow in the ipsilateral vertebral artery. Neurological symptoms were relieved or improved in all three, with no decrease in. Subclavian steal syndrome refers to stenoocclusive disease of the proximal subclavian artery with retrograde flow in ipsilateral vertebral artery and associated cerebral ischemic symptoms.
Steal syndrome stage i retrograde inflow of blood into the access during diastole without complaints is a frequent finding in arteriovenous av fistulae and grafts and needs no intervention. Subclavian steal syndrome sss is a condition secondary to an occlusion in the proximal subclavian artery which leads to upperextremity blood supply to be derived by reversal of flow within the ipsilateral va. Dr jamals usmle notes and match guide 3,620 views 3. The term subclavian steal refers to a phenomenon of flow reversal in the vertebral artery ipsilateral to a hemodynamically significant stenosis or occlusion of the prevertebral subclavian artery. On investigation, subclavian steal syndrome sss was diagnosed. Patients with pain on exercise or during dialysis stage ii, however, require permanent attention in. Danziger from the department of radiology, princess nursing home, esselen street, hillbrow 2001, johannesburg, south africa the subclavian steal syndrome is a wellrecognised clinical entity in which a stenosis or complete obstruction of a subclavian artery is present proxi mal to the origin of the. For patients in whom antegrade vertebral blood flow is reestablished by means of either surgical revascularization or endovascular stenting of the diseased subclavian artery, the. The subclavian arteries are the large arteries which originate from the aorta near the base of the neck and travel under the. The prevalence of the disease remains unknown as most of the patient suffering from subclavian steal syndrome does not seek medical attention.
Get a printable copy pdf file of the complete article 2. Usually iatrogenic and follows coronary artery bypass grafting utilising the internal mammary artery. The risk factors for sss are thus similar to those of atherosclerotic diseases and include smoking, hyperlipidemia, hypertension, diabetes mellitus, family history and age. Subclavian steal syndrome the following case study was a clinical presentation in which i considered subclavian steal syndrome sss within my differential diagnosis. Vertebral artery doppler waveform changes indicating. Coronary subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass.