Subclavian Steal Syndrome

(SSS)

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Cause

- Arterio-occlusive disease of proximal left subclavian artery causing retrograde flow of blood from the left vertebral artery to the left subclavian artery

- Subsequent exercise & arm movements causes neurological defecit

- Caused by: atherosclerosis, Takayasus arteritis, dissecting aortic aneurysm, embolism

 

Features

-  Onset >50 yrs if atherosclerosis

-  Onset <30 yrs if Takayasus arteritis

 

Associated S/S

-  Vertigo, tinnitus

-  Visual loss: amaurosis fugax

-  Transient neuro defecits: ataxia, diplopia, hemiparesis, facial paresthesia

-  Dysarthria, dysphagia

-  >20mmHg systolic BP difference between left & right arms

-  Subclavian bruit

-  Arm claudication on exercise

 

Ix

-  Ultrasound + Doppler: carotid & subclavian arteries

-  Angiography

-  Arch aortography

-  MRA

 

Mx

- As for atherosclerosis

- Mx HTN

- Sx

-  Angioplasty

-  Carotid-subclavian bypass

-  Axillio-axiallry bypass