Subclavian Steal Syndrome
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- A condition that results from stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery; blood is drawn from the contralateral vertebral basilar or carotid artery regions into the low-pressure ipsilateral upper limb vessels, “stealing” the blood flow from the circle of Willis.
- The term was reported for the first time by Fisher in 1961. It is a normal pattern of collateral response to proximal subclavian artery occlusion.
- Predominant age:
- Age >55 years—atherosclerotic etiology
- Age <30 years—90% of patients with Takayasu arteritis
- Predominant sex: Female > Male
- More frequent in African Americans and non-Hispanic whites when compared with Hispanics and Chinese Americans
- Present in 6% of the patients with asymptomatic carotid bruit
- Hemodynamically significant left subclavian artery stenosis is present in ~2.5% of patients undergoing coronary revascularization (1).
- With a left subclavian occlusion, maintenance of blood flow to the left arm occurs with reversal of flow from the basilar artery via the left vertebral artery.
- Symptoms are associated with the degree and location of a second extracranial vessel occlusion.
- Arteriosclerosis obliterans of the proximal subclavian artery in 95% of cases
- Lesions are 4:1 more common on the left side.
- Less common causes of obstruction:
- Dissecting aneurysm of aortic arch
- Radiotherapy induced
- Takayasu arteritis
- Giant cell arteritis
- Fibromuscular dysplasia
- May happen after Blalock-Taussig procedure for tetralogy of Fallot
Commonly Associated Conditions
- Carotid artery disease
- Coronary artery disease is present in 30–60% of patients.
Older patients are more likely to have arteriosclerosis.