A Forgotten Vascular Disease with Important Clinical Implications.Subclavian Steal Syndrome: Case Report and Literature Review

Abstract

SummaryBackground:Subclavian Steal Syndrome (SSS) is a fascinating vascular phenomenon in which a steno-occlusive lesion of the proximal subclavian artery causes retrograde flow in the vertebral artery away from the brain stem subsequently causing vertebrobasilar insufficiency. SSS can present with a myriad of neurological and vascular signs and symptoms, but most commonly this phenomenon presents as an incidental finding in an asymptomatic patient.Case Report:Our patient is a 73-year-old female sent to the cardiology clinic for surgical clearance in preparation for an elective cholecystectomy. Shortness of breath was her only complaint. Review of systems was remarkable for left arm pain and blurry vision with repetitive movement. Physical examination noticeable for absence of left radial pulse. Percutaneous angiography demonstrated a totally occulted left subclavian artery with collateral circulation form the vertebrobasilar apparatus.Conclusions:Atypical presentation of this unique entity represents a challenge for physicians who require a high index of suspicion to make the diagnosis. We present an atypical case with radiographical evidence of the steal syndrome, followed by an extensive literature review of the most current diagnostic methods as well as latest recommendations for treatment options and secondary prevention.

Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

“…This simulates the picture of subclavian steal syndrome. Subclavian steal syndrome is asymptomatic in majority of cases with retrograde flow being dependent on the duration of block in the subclavian artery, size of vertebral arteries and the extent of development of collateral channels 9 . A systolic blood pressure difference of greater than 20 mmHg between upper extremities is highly correlated with the symptoms, complete steal and need of intervention 10 …”

“…Neck vessels are known for collaterals formation. Vertebrocarotid and vertebrosubclavian collaterals are well documented 9, 10, 11, 12. We present a unique case of gunshot injury to neck with right common carotid and right subclavian artery injury, and hemorrhagic shock was managed with ligation of these vessels as a life-saving procedure.…”

Common Carotid Artery Laceration Managed by Clamping at Emergency Department

“…In the penetrating extracranial carotid artery trauma patients, mortality was 21.2% and stroke rate after survival was 15.1% [10]. Of course, the collateral circulation between vertebral artery and subclavian artery is well known [11]. However, it has many variations so that it is dangerous to trust the collateral and sacrifice common carotid artery.…”

A case of acquired right-sided subclavian steal syndrome successfully treated with stenting using brachial approach

“…The most common cause of subclavian artery occlusive disease is atherosclerosis, followed far less often by Takayasu's arteritis. Rarely, radiation-induced atherosclerosis obliterans is a cause [13].…”