Subclavian Steal Syndrome

Question 2

What is subclavian steal syndrome and why does it occur?

Answer 2

Syncope or neurological deficits when the blood supply to the affected arm is increased through exercise

Due to proximal stenosing or occlusive lesion in subclavian artery (atherosclerosis, vasculitis, TOS, aortic coarctation repair)

During exercise blood is taken from collateral circulation from reversed blood flow in ipsilateral vertebral artery, leading to syncope

Question 3

What are some risk factors for subclavian steal syndrome?

Answer 3

Anything that increases the risk of atherosclerosis

• Smoking
• Hyperlipidaemia
• DM
• Smoking
• HTN

Question 4

What are the clinical features of subclavian steal syndrome?

Answer 4

• During arm exercise blood to posterior cerebral circulation reversed so cerebellar symptoms like vertigo, diplopia, dysphagia, dysarthria, visual loss, syncope
• May have arm claudication (pain or paraesthesia) due to occluding lesions

Question 5

How is suspected subclavian steal syndrome investigated?

Answer 5

- Duplex US: shows retrograde flow in vertebral artery during exercise

- CXR: to look for external compression of subclavian artery

- CT angiography: definitive investigation to find occlusion

Question 6

How can the severity of Subclavian Steal Syndrome be classified?

Answer 6

Question 7

How is subclavian steal syndrome managed?

Answer 7

Conservative

• Statin and antiplpatlet therapy
• Modify any CVS risk factors e.g smoking cessation

Surgical

• Endovascular or bypass techniques for occlusion clearance but risk of stroke and damage to brachial plexus
• Percutaneous angioplasty +/- stenting