Subclavian Steal Syndrome—reversal of Cephalic Blood Flow

Patel, Aneel N.; Toole, James F.

doi:10.1097/00005792-196507000-00002

Cited by 79 publications

(12 citation statements)

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“…Adults with the subclavian steal syndrome are often asymptomatic because of autoregulation of CBF and a generous collateral circulation at the circle of Willis; however, with arm exercise, siphoning of blood may lead to symptoms of cerebral ischemia. 17 In summary, there is evidence from various settings that abnormal diastolic blood flow can significantly affect end-organ performance.…”

Section: Physiology Of Ductal Stealmentioning

confidence: 99%

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

et al. 2010

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Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities, such as necrotizing enterocolitis and intraventricular hemorrhage. This may be attributable, at least in part, to systemic hypoperfusion secondary to ductal steal. A hemodynamically significant ductus arteriosus (HSDA) is known to be associated with altered systemic blood flow and end-organ hypoperfusion. Although descending aorta blood flow profiles may show abnormal diastolic retrograde flow, Doppler studies of blood flow in the systemic arteries may help improve our understanding of the relationship of a HSDA with these morbidities. In this article, we discuss aspects of diastolic blood flow reversal in the systemic arteries in premature infants with a hemodynamically significant duct. Whether these hemodynamic effects are significant enough to form the basis for initiating treatment is still unclear; these should form the basis for prospective studies.

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Section: Physiology Of Ductal Stealmentioning

confidence: 99%

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

et al. 2010

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“…In this situation, the anatomic lesion responsible for producing retrograde blood flow in the vertebral artery is stenosis of the subclavian artery proximal to the origin of the vertebral artery. Such an obstruction may be congenital [2,10,13] or acquired [13]. A subclavian artery steal may also arise as a complication of a classic B-T anastomosis [7].…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, cerebral ischemia may occur either spontaneously from inadequate collateral circulation (supply) to the upper extremity or secondary to excess stress (demand) on the affected arm. Likewise, malformations of the innominate artery can lead to a subclavian artery steal [2,13]. In this lesion, the flow of blood in both the ipsilateral vertebral and the common carotid arteries reverses and drains off into the subclavian artery.…”

Section: Discussionmentioning

confidence: 99%

Innominate Artery Steal Syndrome After Stage I Palliation for Hypoplastic Left Heart Syndrome

et al. 1998

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Four neonates with hypoplastic left heart syndrome (HLHS) were found to have innominate artery steal syndrome (IASS) following stage I palliation with a modified Blalock-Taussig (B-T) shunt. All patients presented in the early postoperative period with a persistent supplemental oxygen requirement. Two-dimensional echocardiography with Doppler flow analysis and cardiac catheterization with angiography demonstrated obstruction at the origin of the innominate artery. This obstruction was associated with intermittent retrograde flow through the right vertebral and common carotid arteries into the distal innominate artery and modified B-T shunt. An ascending neoaorta to right pulmonary artery shunt, with takedown of the B-T shunt, was performed in two of the patients. The other two patients were treated with percutaneous balloon dilatation of the obstructed area. Both procedures improved arterial blood oxygen saturations and eliminated the need for supplemental oxygen. In three of four patients, the left common carotid artery was found to be larger than the right. All four patients developed microcephaly, and one patient had encephalomalacia in the distribution of the right anterior and middle cerebral arteries. The development of IASS following stage I palliation for HLHS and the association of neurologic sequelae from this complication are discussed.

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“…A clinicopathological study of a large series [17] shows that (1) vertigo is closely related to atherosclerosis of the vertebrobasilar system, and (2) the incidence of vertigo is significantly higher in the group with stenosis of more than 50% of the basilar artery. Dizziness may occur as a symptom of the 'subclavian steal syndrome' [15,20,21,30] due to transient is chemia of the labyrinth on the side of the 'pulseless limb' when that limb is exercised. ENG may help to corroborate this diagnosis by recording in the dark room nystagmus and/or caloric vestibular asymmetry, which may not be apparent at bedside clinical examination [27,28], De Kleyn [7] first demonstrated in 1927 that simple rotation of the neck while the head was kept fixed caused dizziness and nystagmus, which he attributed to vertebrobasilar artery insufficiency.…”

Section: Commentmentioning

confidence: 99%

Electronystagmography in Neurological Diagnosis

Toglia¹

1979

Stereotact Funct Neurosurg

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Electronystagmography (ENG) is a technique for recording nystagmus and other eye movements; our technique, based on the utilization of a bioelectrical potential which exists between the retina and the cornea, has been reported in detail elsewhere in a monograph [29]. ENG has been used particularly by otologists to record caloric nystagmus and study labyrinthine function [2, 4, 16, 19]. This technique should have even greater applications in the diagnosis of neurological disease, since nystagmus and abnormalities of ocular and vestibular functions are symptoms frequently encountered by the neurologist. This paper illustrates this point with three case reports.

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Subclavian Steal Syndrome—reversal of Cephalic Blood Flow

Cited by 79 publications

References 0 publications

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

Innominate Artery Steal Syndrome After Stage I Palliation for Hypoplastic Left Heart Syndrome

Electronystagmography in Neurological Diagnosis

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