J Korean Surg Soc.  2009 Mar;76(3):203-206. 10.4174/jkss.2009.76.3.203.

Subclavian Steal Syndrome

• Jung MS
• Hong SI
• Kim HS
• Lee JH
• Kim HJ
• Ryu BY
• Kim HK

• KMID: 2096545
• DOI: http://doi.org/10.4174/jkss.2009.76.3.203

Abstract

The definition of subclavian steal is the reversal of vertebral blood flow resulting from the stenosis or occlusion of one of the subclavian arteries or the innominate artery. It is a rare disease resulting in a variety of ischemic neurologic symptoms such as vertigo, dizziness, diplopia, dysarthria, ataxia and nystagmus. Some patients show ischemic symptoms and digital necrosis of the involved arm. Among treatment options, Subclavian to carotid transposition is the most preferred method. We report a patient with subclavian steal syndrome who had 5th finger necrosis of the left hand without neurologic symptoms. It was successfully treated with a carotid-subclavian bypass with a 6 mm ePTFE graft.

Keyword

Subclavian steal syndrome; Carotid-subclavian bypass

MeSH Terms

Arm
Ataxia
Brachiocephalic Trunk
Constriction, Pathologic
Diplopia
Dizziness
Dysarthria
Fingers
Hand
Humans
Necrosis
Neurologic Manifestations
Rare Diseases
Subclavian Artery
Subclavian Steal Syndrome
Transplants
Vertigo

Figure

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  Fig. 1 Conventional angiogram of right vertebral artery. Angiogram shows the reverse flow of right vertebral artery via left vertebral artery and basilar artery. This is the pathologic finding of subclavian steal.

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  Fig. 2 Conventional angiography for left arm. (A) Arotic arch angiography shows occlusion of left proximal subclavian artery (arrows). (B) The vascular structures of left arm are visualized via reversed left vertebral flow. Brachial, radial, unlar artery was directly visualized. There is no evidence of arterial stenosis or obstruction.

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  Fig. 3 CT - Chest. About 4 cm sized mass with central cavitation in RUL (arrow heads). Slightly enlarged lymph nodes are shown in the right lower paratracheal area. About 3 cm length, short, segmental luminal obstruction was found at the proximal left subclavian artery (arrows).

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