Subclavian steal syndrome Flashcards
What is subclavian steal syndrome?
rare condition causing syncope or neurological deficits when the blood supply to the affected arm is increased through exercise
What is subclavian steal syndrome secondary to?
proximal stenosing lesion or occlusion in the subclavian artery
How does the body compensate for the increased oxygen demand i the arm in subclavian steal syndrome?
Blood is drawn from the collateral circulation which results in reversed blood flow in the ipsilateral vertebral artery
What causes stenosis in the subclavian artery?
atherosclerosis mainly but also vasculitis, Thoracic outlet syndrome, aortic coarctation repairer
What is Coronary subclavian steal syndrome?
occurs after an internal mammary artery graft, increased demand i the left arm then steals blood from the IMA causing cardiac ischaemia
What are the risk factors for subclavian steal syndrome?
atherosclerosis so increasing age, hyperlipidaemia, hypertension, smoking, diabetes mellitus
What are the clinical features of subclavian steal syndrome?
reversal of blood supply to the posterior cerebral circulation via the vertebral artery can result in symptoms such as vertigo, diplopia, dysphagia, dysarthria, visual loss or syncope, arm claudication due to occluding lesions such as arm pain or paraesthesia, made worse with arm movement
What are the investigations for subclavian steal syndrome?
duplex US scan, shows retrograde flow in the affected vertebral artery during exercise, routine chest X-ray can assess external compression on the subclavian artery, CT angiography or MR angiography which will identify the anatomy of the occlusive lesion in the arm and can help to assess the cerebral vasculature
What is the management for subclavian steal syndrome?
anti-platelet and statin therapy, reduce smoking, weightless, diabetes control, endovascular or bypass technique, percutaneous angioplasty and standing
