subclavian steal syndrome patient report

The subclavian steal syndrome is usually asymptomatic and is often diagnosed incidentally. Notably, it was first reported by Contorni in 1960 [ 3 ]. He was unable to palpate his patient’s radial artery, and subsequent angiography revealed stenosis of the artery.

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How to diagnose subclavian steal syndrome?

The severity of subclavian steal is classified into three grades[8]:

• Grade I (pre-subclavian steal) - reduced antegrade vertebral flow.
• Grade II (intermittent/partial) - alternating flow - antegrade flow in the diastolic phase and retrograde flow in the systolic phase.
• Grade III (permanent/advanced) - permanent retrograde vertebral flow.

What is the prognosis of for subclavian steal syndrome?

With subclavian steal syndrome, if neurologic symptoms do occur, they tend to be transient (eg, hypoperfusive transient ischemic attack) and seldom lead to stroke. 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 prognosis is highly favorable.

What are the treatment options for subclavian steal syndrome?

Treatment and management

• Lifestyle changes. People with atherosclerosis and other cardiovascular conditions can make certain lifestyle changes to help manage their condition.
• Medications. Sometimes, lifestyle changes alone are not enough to address the underlying cause of subclavian steal syndrome.
• Surgery. ...

How to diagnose subclavian steal?

Ultrasound

• retrograde flow in the ipsilateral vertebral artery
• early changes prior to reversal of flow: decreased velocity, biphasic flow (in the vertebral artery), including bunny waveform sign
• changes can be augmented with arm exercise or inflation of BP cuff above systolic pressure
• proximal subclavian artery usually cannot be seen well enough to assess

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How do you diagnose subclavian steal syndrome?

Confirmation of a steal syndrome is usually made by imaging studies. All imaging tools can be used to detect subclavian stenosis and to observe reversal of flow from the vertebral artery. Carotid duplex ultrasound(US) is the most used and usually the first diagnostic test.

What are symptoms of subclavian steal syndrome?

A 2020 article lists the following common neurological symptoms of subclavian steal syndrome:hearing loss.tinnitus.blurred vision.dizziness.vertigo.loss of muscle coordination, or ataxia.fainting.

What happens in subclavian steal syndrome?

The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. In this case, the subclavian artery steals reverse-flow blood from the vertebrobasilar artery circulation to supply the arm during exertion, resulting in vertebrobasilar insufficiency.

Is steal syndrome painful?

Hemodialysis access-related hand ischemia or 'steal syndrome' causes problems such as hand numbness, pain, coldness and weakness, as well as significantly reduced blood flow/pressure to affected tissues. In extreme cases, it can cause tissue death (gangrene), which may lead to the loss of fingers.

How is steal syndrome diagnosed?

The diagnosis of steal is based on an accurate history and physical examination and confirmed with tests including an arteriogram, duplex Doppler ultrasound (DDU) evaluation with finger pressures and waveform analysis. Treatment of steal includes observation of developing symptoms in mild cases.

How does subclavian steal syndrome affect blood pressure?

In this condition, occlusive disease in the proximal subclavian artery can lead to a siphoning of blood away from the brain by a reversal of flow down the vertebral artery on the affected side to the ischemic limb. The pulse and blood pressure are diminished in the affected limb.

What happens when subclavian artery is blocked?

Subclavian Steal Syndrome is a blockage of the subclavian artery which sits under the collarbone. It delivers blood to the arm and brain. The blockage causes the blood to flow in reverse. The arm "steals" blood flow from the blood which was intended for the posterior (back side) of the brain.

How is subclavian steal syndrome treated?

Patients with burdensome symptoms and proximal subclavian artery occlusive disease can be successfully treated either surgically or percutaneously. Balloon angioplasty and stenting can be performed when stenting is unlikely to compromise the vertebral circulation.

What happens if the right subclavian artery is blocked?

When the subclavian artery is blocked or severely narrowed, blood cannot flow into the subclavian artery from the aorta. Instead, the subclavian artery sometimes 'steals' blood from the vertebral artery above it (shaded), which should normally supply the brain.

Can Steal Syndrome be reversed?

Mild cases can be observed closely, most of them will reverse in a few weeks. In order to prevent permanent sequela, severe cases require immediate intervention. Several surgical treatments have been used: access ligation, banding, elongation, distal arterial ligation, and distal revascularization-interval ligation.

What does subclavian artery pain feel like?

You may experience arm pain or muscle fatigue when using your arms above your head, or doing any activity that demands more oxygen-rich blood flow to the arms. Other symptoms can include: Dizziness (vertigo) with arm activity. Feeling as if you might pass out.

Does subclavian steal syndrome cause headaches?

The decreased blood flow to the posterior brain and upper extremity on the affected side results in a range of symptoms. Vertebrobasilar insufficiency may produce light-headedness, dizziness, ataxia, vertigo, visual disturbances, motor deficits, confusion, focal seizures, aphasia, headaches or syncope.