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Subclavian Steal Syndrome

A Message from the Heart to the Heart
Saad Pervez
(Honours Bachelor of Science: Double Major in Neuroscience and Integrative Biology)
University of Toronto, Canada

Idea of and reviewed by:
Dr.A. Arrazaghi,MBBCH,FDABIM,FRCPC,
Specialist of internal medicine and cardiovascular diseases, University of Toronto


SUBCLAVIAN STEAL SYNDROME
In order to understand Subclavian steal syndrome(SSS), we need to figure out the role of subclavian artery. The subclavian artery are blood vessels of the upper limbs which is located in the upper thorax. They received blood from the apex of the aorta and supply it to the left and right arms. The Subclavian Artery branch to the vertebral arteries which carry oxygenated blood to the brain from the bottom of the neck.



WHAT IS SUBCLAVIAN STEAL SYNDROME?
SSS is a relatively uncommon form of peripheral artery disease in which a blockage is present in a critical location within one of the subclavian arteries resulting symptoms that involve both the arm and the brain.. It is more common in men than women and it usually occurs over 55 years of age. SSS can occur if there is a complete or partial blockage in the subclavian artery just prior to the take-off of the vertebral artery. When the arm supplied by the blocked subclavian artery is exercised, blood can be drawn away from the brain, via the vertebral artery, to supply the exercising arm. So during arm exercise, a patient with SSS can experience not onlyclaudication of the affected arm, but also symptoms related to insufficient blood flow to the brain.These neurological symptoms may include loss of consciousness, double vision and other visual disturbances, ringing in the ears, vertigo, or dizziness.( Richard, 2011)



Causes
. Arteriosclerosis of subclavian artery (95% of cases)
. Dissecting aortic aneurysm
. Embolism and Takayasu's Arteritis


Signs
. Reduced radial and ulnar pulses on affected side
. Blood Pressure difference (i.e.. greater than 20 mmHg between arms)
. Subclavian bruit
. Radial pulse disappears on arm Exercise or elevation




Symptoms
. Light-headedness or Dizziness
. Ataxia or Vertigo
. Visual disturbance and Motor Deficit
. Confusion
. Focal Seizure
. Aphasia, Headache and Syncope
. Arm weakness
. Arm coldness or Paresthesias
. Arm Claudication with Exercise
. Vigorous Exercise of affected arm
. Sudden turning of head to affected side


Investigations
. Colour Doppler ultrasound.
. CT angiography: shows retrograde flow down vertebral arteries.
. MRI Scan
. ECG


Management
. Axillo-axillary bypass
. Carotid-Subclavian bypass
. Percutaneous transluminal Angioplasty with stenting


Treatment
. Medical Therapy
. Angioplasty




Risk Factors
As the majority of cases are due to atherosclerosis, risk factors for SSS are as for cardiovascular disease in general: . Family history of vascular disease
. Smoking
. Hypertension
. Diabetes
. Hyperlipidaemia