Subclavian steal refers to a syndrome of symptoms relating to arterial insufficiency in a branch of the subclavian artery stemming from flow reversal, attributable to occlusive disease in the subclavian artery proximal to that branch that is usually atherosclerotic in cause. Subclavian steal syndrome is a rare cause of transient ischemic attacks the fancy word for ministrokes. 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. Subclavian steal syndrome is a relatively uncommon form of peripheral artery disease pad in which a blockage is present in a critical location within one of the subclavian arteries, causing symptoms that involve both the arm and the brain. For claims with a date of service on or after october 1, 2015, use an. In most cases, subclavian steal is asymptomatic ie, subclavian steal phenomenon, does not warrant invasive evaluation or treatment, and represents an appropriate physiological. Sss is an interesting presentation intertwined within a number of other pathologies that can muddy the water. Subclavian steal syndrome sss has since been defined as a group of symptoms that arise from this reversed blood flow in the ipsilateral vertebral artery. The blockage or narrowing is usually caused by plaques from atherosclerosis. Exercising the arm causes the blood flow to reverse and the subclavian artery steals blood from the vertebral artery. The subclavian steal syndrome is a wellrecognized clinical and radiographic entity that involves the left subclavian artery far more commonly than the right.
Although takayasu arteritis is an infrequent cause of the syndrome, it occurs more commonly in people of asian descent. We report a case of bilateral subclavian steal secondary to total occlusion of the. Click on the image or right click to open the source website. 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 definition of subclavian steal. Steal syndromes peripheral arterial disease accesscardiology. 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 sss is caused by a hemodynamically critical proximal subclavian artery stenosis or occlusion with subsequent retrograde filling of the. The subclavian steal syndrome is a rare but important cause of syncope.
In this condition, there is a reverse flow of blood in the vertebral artery or the. 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. Subclavian steal occurs when a subclavian artery stenosis proximal to the vertebral origin causes retrograde flow in the ipsilateral va. Subclavian steal syndrome sss merupakan sindrom yang disebabkan penyempitan atau penyumbatan arteri subclavia.
The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. A case report subclavian steal syndrome is caused by retrograde vertebral artery flow stealing vertebrobasilar perfusion. There is an increased incidence with age and the greater male predilection with a m. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. 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 a systemic entity that is well documented in the medical literature. 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. 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. Subclavian steal syndrome clinical maze clinical maze. Subclavian steal syndrome and cerebral hypoperfusion during hemodialysis. Patients should address specific medical concerns with their physicians. 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.
Subclavian steal syndrome radiology reference article. Bilateral subclavian steal syndrome is a rare condition. 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. Atherosclerosis is the most common cause of subclavian steal syndrome. 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. It is often a differential diagnosis in any patient who presents with a pulse deficit or a systolic blood pressure difference of greater than 20 mmhg between the arms. 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. Right subclavian steal associated with aberrant right subclavian artery david m. Subclavian steal syndrome with or without arterial stenosis. Case reports in cardiology vol 2011, article di 146267 d.
Due to acute origin of left subclavian artery resulting in accelerated atherosclerosis due to turbulent blood flow, it is the most commonly affected artery 72% versus the right subclavian artery and innominate artery. It is usually due to reversal of vertebral blood flow in the setting of bilateral proximal subclavian or left subclavian plus innominate artery severe stenosis or occlusion. Subclavian steal syndrome the following case study was a clinical presentation in which i considered subclavian steal syndrome sss within my differential diagnosis. The term subclavian steal describes retrograde blood flow in the vertebral artery associated with proximal ipsilateral subclavian artery stenosis. Subclavian steal syndrome occurs when there is the presence of an occlusion or narrowing in the subclavian artery. Subclavian steal syndrome knowledge for medical students. Coronary steal phenomenon cardiac steal syndrome general cardiology dr jamal usmle duration. The symptoms of cerebral vascular insufficiency not enough blood to the brain when the patient exercises an arm, due to obstruction of the subclavian artery before the origin the takeoff of the vertebral artery. Subclavian steal syndrome brachial basilar insufficiency. Tinjauan pustaka penegakan diagnosis dan penatalaksanaan.
Subclavian steal is usually an accidental finding since it rarely produces neurologic symptoms. The decreased blood flow to the posterior brain and upper extremity may cause lightheadedness, dizziness, ataxia, vertigo, visual. Pdf the subclavian steal syndrome is a condition that results from the stenosis or occlusion of the subclavian artery proximal to the origin of the. Subclavian steal syndrome 5minute clinical consult. 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 is a hemodynamic condition of reversed flow in one vertebral artery to compensate for a proximal hemodynamic lesion in the unilateral subclavian artery 289, thus, blood flow is diverted or stolen from the brain to feed the arm.
Bilateral subclavian steal syndrome europe pmc article. This finding may cause cerebral ischemia related to upper extremities exercise. Although access to this page is not restricted, the information found here is intended for use by medical providers. Percutaneous angioplasty and stenting of left subclavian artery lesions for the treatment of patients with concomitant vertebral and coronary subclavian steal syndrome. The correlation between waveform type and subclavian disease was statistically significant p 0. Wed like to understand how you use our websites in order to improve them. Subclavian steal syndrome as the presenting feature bioline. 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.
The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right. Subclavian steal syndrome and other insufficiencies. The subclavian steal syndrome is a condition that results from the stenosis or occlusion of the. These images are a random sampling from a bing search on the term subclavian steal syndrome. 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. Subclavian steal phenomenon often involves highgrade stenosis andor occlusion of the subclavian artery, leading to a decrease in the sa pressure distal to the lesion figure 1. 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 full text of this article is available as a pdf 84k. In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. Subclavian steal syndrome sss refers to a vascular disorder, a rare form of periphery artery disease in which a blockage is present in a critical location within one of the subclavian arteries which gives rise to problems involving the arm and the brain.
Subclavian steal syndrome circulation aha journals. Subclavian steal syndrome, or sss, is a syndrome caused by a blockage or narrowing in the subclavian artery. Management of the subclavian steal syndrome comment this patient showed no hyper tension and no arm claudication, nor were any other symptoms provoked by arm exercise. 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. Subclavian steal syndrome, also called subclavian steal phenomenon or subclavian steal stenoocclusive disease, 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. A subclavian steal syndrome may occur when a significant stenosis in the subclavian artery compromises distal perfusion to the ima, vertebral.
Pulsatile tinnitus is a rare but potentially disabling symptom, which can be caused by both vascular and nonvascular abnormalities 1, 2. If the stenosis is severe and the affected arm is exerted, this pressure drop can cause the blood flow in the ipsilateral vertebral artery to reverse, stealing the blood from the. Subclavian steal syndrome causes, symptoms, diagnosis. The symptoms such as confusion, dizziness, weakness, numbness, visual difficulties, slurred speech occur with exertion of the arm supplied by the subclavian artery that is affected. Vertebral artery doppler waveform changes indicating. In medicine, subclavian steal syndrome, also called subclavian steal phenomenon or subclavian steal stenoocclusive disease, is a constellation of signs and symptoms that arise from retrograde flow of blood. The redundancy in the circulation in the brain and the retrograde flow of the blood as a consequence of the occlusion and narrowing in the subclavian artery resulted to the syndrome. 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. Therefore, with a simple physical examination, the clinician can effectively eliminate significant subclavian arterial lesions without the need for angiography. Subclavian steal syndrome sss, also called subclavian steal phenomenon or subclavian steal stenoocclusive disease, is a constellation of signs and. 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. The subclavian steal, in the absence of other anatomical anomalies, is usually asymptomatic and often an incidental finding. Right subclavian steal associated with aberrant right.