Subclavian steal syndrome

Abstract

"Subclavian steal" refers to a syndrome of symptoms relating to arterial insufficiency in a branch of the subclavian artery stemming from flow reversal, attributable to occlusive disease in the subclavian artery proximal to that branch that is usually atherosclerotic in cause. Most patients are asymptomatic, but patients with IMA bypass grafts may manifest angina elicited by exercise of the upper extremity ipsilateral to the graft and stenosis (socalled "coronary-subclavian steal"). Subclavian steal may also manifest as vertebrobasilar insufficiency or, most commonly, arm claudication. Subclavian steal should be considered among patients exhibiting suggestive symptoms. A meticulous examination of segmental pulses and pressures, as well as judicious use of duplex ultrasonography, magnetic resonance angiography, computed tomography angiography, or conventional angiography can confirm the presence of subclavian stenosis. Symptomatic patients benefit from either percutaneous or surgical revascularization, depending on both anatomic and patient factors. Subclavian stenosis, regardless of symptoms, is a marker of atherosclerotic disease and increased risk for cardiovascular and cerebrovascular events. © 2014 American Heart Association, Inc.