Journal List > J Korean Surg Soc > v.76(3) > 1010939

J Korean Surg Soc. 2009 Mar;76(3):203-206. Korean.
Published online March 31, 2009.  https://doi.org/10.4174/jkss.2009.76.3.203
Copyright © 2009 The Korean Surgical Society
Subclavian Steal Syndrome
Min Seong Jung, M.D., Sung Il Hong, M.D., Hae Sung Kim, M.D., Jeong Hoon Lee, M.D., Han Joon Kim, M.D., Byoung Yoon Ryu, M.D. and Hong Ki Kim, M.D.
Department of Surgery, College of Medicine, Hallym University, Chuncheon, Korea.
Received May 28, 2008; Accepted September 18, 2008.

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.

Keywords: Subclavian steal syndrome; Carotid-subclavian bypass

Figures


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.
Click for larger image


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.
Click for larger image


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).
Click for larger image

References
1. Fisher CM. A new vascular syndrome? 'the subclavian steal'. N Engl J Med 1961;265:912–913.
2. Zimmerman NB. Occlusive vascular disorders of the upper extremity. Hand Clin 1993;9:139–150.
3. Webster MW, Downs L, Yonas H, Makaroun MS, Steed DL. The effect of arm exercise on regional cerebral blood flow in the subclavian steal syndrome. Am J Surg 1994;168:91–93.
4. Welling RE, Cranley JJ, Krause RJ, Hafner CD. Obliterative arterial disease of the upper extremity. Arch Surg 1981;116:1593–1596.
5. Pollard H, Rigby S, Moritz G, Lau C. Subclavian steal syndrome: a review. Australas Chiropr Osteopathy 1998;7:20–28.
6. Schardey HM, Meyer G, Rau HG, Gradl G, Jauch KW, Lauterjung L. Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg 1996;12:431–436.
7. Mingoli A, Feldhaus RJ, Farina C, Schultz RD, Cavallaro A. Comparative results of carotid-subclavian bypass and axillo-axillary bypass in patients with symptomatic subclavian disease. Eur J Vasc Surg 1992;6:26–30.
8. Koh YB, Suh KH, Lee YK. Successful correction of subclavian steal syndrome by proximal axillo-axillary bypass graft with autogenous Saphenous vein. J Korean Surg Soc 1980;22:67–73.
9. Do BS, Suh BY, Kwun KB. Axillo-axillary artery bypass graft for the treatment of subclavian steal syndrome: experience of 3 cases. J Korean Vasc Surg Soc 1991;7:36–41.
10. Erbstein RA, Wholey MH, Smoot S. Subclavian artery steal syndrome: treatment by percutaneous transluminal angioplasty. AJR Am J Roentgenol 1988;151:291–294.