Subclavian Steal Syndrome – Symptoms, Treatment, Causes, Prevention

What is Subclavian Steal Syndrome?

When there is an occlusion or stenosis in the person’s Subclavian area or at the segment located between the aortic arch’s origin and the vertebral artery’s origin, it will result to having this kind of syndrome. Also, whenever the proximal part of the Subclavian artery is obstructed, it will result to the Subclavian steal syndrome.

It is a condition wherein there is an abnormal backward flow or a reverse of blood flow from the vertebral artery circulation which may be sometimes provoked whenever one does an exercise of the ipsilateral arm. Meanwhile, other experts would describe it as the significant hemodynamical stenosis of the person’s Subclavian artery.

This is a rare kind of syndrome. It is an insufficiency of the cerebrovascular system that results to vertebrobasilar ischemia which is seen whenever one exercises the ipsilateral arm. It also results to a fall of the post stenotic perfusion pressure located at the Subclavian artery which is distal to the area of the lesion.

Symptoms and Signs

When a person is diagnosed with having Subclavian steal syndrome, he or she will experience or manifest some of the following symptoms and signs:

• Numbness
• Claudication
• Tingling
• Muscle wasting
• Dizziness
• Syncope
• Vertigo
• Unsteadiness
• Occipital headache
• Tinnitus
• Nystagmus
• Disequilibrium
• Cerebellar dystaxia
• Finger gangrene
• Transient global amnesia
• Occipital headache
• Temporary blindness
• Hemianopia
• Diplopia
• Ocular motility disturbances
• Decrease blood pressure
• Systolic bruit
• Hemiparesis
• Dysarthria
• Persons with status post connective surgery and CHD or congenital heart disease

Causes and Risk Factors

According to studies conducted, the reason behind why some persons are diagnosed with this kind of syndrome is primarily because of either of the following etiology:

• Atherosclerosis wherein there are fatty substances that molds into a plaque deposits on the innermost lining of the walls of the artery, which in this case the Subclavian artery.
• Congenital lesions including coarctation of the atresia and aorta of the Subclavian artery’s proximal part.
• Inflammatory angiopathy like Takayasu disease which leads to the reversed blood flow.
• Subintimal dissection of the proximal Subclavian artery which may be as a result of hyperextension or can either be spontaneous in nature or perhaps injuries to the person’s left arm that are avulsed will also lead to Subclavian steal syndrome.

Diagnosis

The physicians are the ones who diagnosed persons who have Subclavian steal syndrome. The physician will do the following examination for confirmation:

• Medical history examination to be able to determine if the person has a history of heart disease which has a great correlation and association with the Subclavian steal syndrome
• Physical examination the physician uses the IPPA assessment, which stands for Inspection, Palpation, Percussion, and Auscultation of the person
• Doppler Ultrasound examination of the vertebral and carotid blood circulation
• Computed tomography multidetector scans with enhancement through the use of a contrast dye
• Magnetic resonance imaging without the use of contrast iodinated dye
• Radiographic contrast angiography which is an invasive procedure
• Magnetic resonance angiography which is also an invasive procedure done and is one of the most reliable and confirmatory diagnostic examination

Treatment

Persons with Subclavian steal syndrome are treated with the following treatment:

Pharmacological treatment

• Endothelial independent. vasodilator medications such as calcium channel blockers and nitroglycerin
• Anti-platelets agent such as aspirin
• Anti-cholesterol drugs which are drugs that ends with “statin”
• Anti-hypertensive drugs

Independent treatment

It is advisable that the patient reduce metabolic demands temporarily such as having bed rest or arm rest

Surgical treatment

• Connective surgery such as fistula repair
• Percutaneous transluminal angioplasty such as stenting
• Surgical vascular bypass surgery of the narrowed artery
• Extra anatomical revascularization surgical correction procedure

Prognosis

The prognosis is the correlation of the grading which is clinically made upon admission together with the symptoms manifested and experienced. Since this kind of syndrome occurs very rare, the prognosis has not been clearly characterized.

The person’s prognosis will depend upon the extent of the present symptoms and the presence also of disease particularly the cerebrovascular kind of disease. Yet, there are studies that shows that those who had Subclavian steal syndrome has not encountered or experience having stroke. Those persons most specifically in the ipsilateral vertebral artery are the ones who don’t suffer from stroke.

Complications

If, for instance, the person can’t tolerate the treatment provided or given to then, then complications will arise. Such complications that are associated with Subclavian steal syndrome are as follows:

Embolization

It is an embolus obstruction of the Subclavian artery. By embolus, it means that the cause of the obstruction is due to materials which are undissolved and is carried by blood. This embolus travels in the person’s artery and later lead to clogging of that particular artery, in this case the Subclavian artery.

Stroke

The person with Subclavian steal syndrome may have the possibility to experience stroke especially if the person undergoes clogging of the Subclavian artery and hence, leading to the lack of blood supply which later progresses to stroke.

Death

This is the last complication, the person with Subclavian steal syndrome, if he or she can’t tolerate the disease condition anymore, he or she may lead to this complication.

Prevention

For prevention of the Subclavian steal syndrome, it is advised that you do the following:

• Ancillary evaluation for peripheral or coronary artery disease
• Risk management for cardiovascular disease
• Undergoing regular re-evaluation for the unsuccessful treatment done such as failure of interventions for the cardiovascular system or medical therapy

Also, in preventing the Subclavian Steal syndrome to get worst, you must follow the prescribed medication whole heartedly; do the non-interventional therapy and undergo the suggested surgical procedure.