Subclavian artery stenosis: A review for the vascular medicine practitioner

Abstract

Peripheral artery disease assessment typically focuses on the evaluation of lower extremity symptoms and physical findings. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae. A review of the existing literature through PubMed using the search term 'subclavian stenosis' was performed. The latest original articles, including clinical studies, case reports and limited reviews of this topic were adapted. A comprehensive article review focusing on the diagnostic and treatment approach for subclavian stenosis was prepared. In conclusion, vascular medicine practitioners including cardiologists and vascular surgeons caring for patients with arterial disease should routinely assess for subclavian stenosis. There are excellent screening tools and effective medical therapies which can be instituted if diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness.

Subclavian Steal Syndrome

“…"Subclavian steal syndrome" can become manifest in some patients with symptoms of arterial insufficiency afflicting the brain, [1][2][3] the upper extremity, 2 or even the heart if part of the coronary circulation is supplied via an IMA graft, 4 as was the case in this patient.…”

“…Physical examination findings suggestive of subclavian stenosis include a discrepancy of >15 mm Hg in blood pressure readings taken in both upper extremities, delayed or decreased amplitude pulses in the affected side, and a bruit in the supraclavicular fossa. 2,[8][9][10] A bruit in the suboccipital area may also be heard. The skin and nails of the affected side should be examined to rule out atrophic changes attributable to arterial insufficiency.…”

“…Atherosclerosis is the most common cause of subclavian stenosis and, thus, steal syndromes, irrespective of the clinical manifestation. 2,5,6 However, large artery vasculitis, thoracic outlet syndrome, and stenosis after surgical repair of aortic coarctation or tetralogy of Fallot (with a Blalock-Taussig shunt) are other possible causes. Congenital abnormalities, such as a right-sided aortic arch with an isolated left subclavian artery, can also lead to subclavian narrowing and steal syndromes and should be considered, particularly if a steal syndrome develops in a younger patient.…”

Subklavian Arter Hastalığında kobalt krom stentlerin uygulaması

“…Atherosclerosis is the most common cause of subclavian artery disease. In addition, arteritis, inflammation due to radiation exposure, compression syndromes, fibromuscular dysplasia and neurofibromatosis may cause subclavian artery disease [1]. LSAD is diagnosed four times as frequently as right subclavian artery or innominate arteries [10][11][12].…”

“…One of the ischemic problems influencing the upper extremities is subclavian artery stenosis [1]. Atherosclerosis is the major reason for upper extremity artery steno-occlusive process [2].…”