Subclavian Steal Syndrome

Subclavian Steal syndrome is when blood flow is stolen from the back part of the brain (cerebellum). The subclavian artery supplies blood flow to the arms. The vertebral arteries supply blood to the back of the brain (cerebellum). The vertebral arteries arise from the subclavian artery, usually beyond the area that plaque forms in the subclavian artery. So, if there is reduced flow to the arm, there is also usually reduced flow to the cerebellum. The cerebellum is the balance center as well as the visual center of our body. If blood is stolen from the cerebellum to supply the arm (subclavian steal), patient's may experience symptoms related to reduced flow to the cerebellum. The patient will also have symptoms related to reduced flow to the arm.

Symptoms

• Usually, symptoms are one sided, most commonly on the left side
• Fatigue, Aching or pain in the affected arm with active use of that arm
• Dizziness, unsteadiness, especially when using the affected arm
• Ulcers on the fingers or even gangrene in fingers
• Visual disturbances
• Muscle atrophy

Risk factors

• Advanced age
• A family history of heart attacks (coronary artery disease/CAD), artery blockages in the legs, leg amputations (peripheral arterial disease/PAD), or strokes (cerebrovascular disease/CVD)
• Cigarette smoking
• High cholesterol (hypercholesterolemia)
• Diabetes mellitus
• High blood pressure (hypertension)

Diagnosis

• Decreased blood pressure on the side of the blockage (compared to the other arm)
• Diminished pulse on the side of the blockage
• Ultrasound of the carotid/vertebral arteries
• CTA brain and arm
• Arteriogram of the arm

Treatment

• Often, if a patient doesn't have symptoms, or the symptoms are mild, it can be treated medically (stop smoking cigarettes, cholesterol lowering drugs, weight loss, blood sugar control).
• If treatment is necessary, it can most often be treated at Paducah Vascular Institute with minimally invasive stent placement across the narrowing or blockage. Sometimes, it may require a surgical procedure in the operating room at the hospital (bypass or transposition).