Subclavian steal syndrome

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Classification according to ICD-10
G45.8 Other transient cerebral ischemia and related syndromes
ICD-10 online (WHO version 2019)
Angiographic representation of the subclavian steal syndrome: the catheter from the left arm is placed over the stenosis at the exit of the subclavian artery on the left into the aortic arch. The contrast medium flows from here primarily into the brachiocephalic trunk, the left common carotid artery and only minimally into the left subclavian artery. The left vertebral artery is contrasted retrograde from cranial to caudal and also supplies the left subclavian artery.

The subclavian steal syndrome or subclavian tap syndrome (also vertebral tap syndrome ) is one of the so-called tap phenomena ( steal syndromes ) and describes blood pressure drops or fluctuations distal to temporary or incomplete vascular occlusions ( stenoses ) of the subclavian artery (or in front of the shoulder girdle) Vertebral artery .

Usually the left shoulder girdle artery is affected. After intensive muscle work, for example when working with the arm above the head, blood can flow from the vertebral artery (now fed from the opposite side) into the subclavian artery, as a result of which the blood pressure falls in the supply area of ​​the vertebral artery on the same side towards the basilar artery . This is then a reversal of the flow . In particularly severe forms of subclavian steal syndrome, symptoms can occur even in the absence of physical work. The syndrome can be diagnosed by a difference in blood pressure in the two arms and auscultation over the artery in the stethoscope . The iliofemoral steal syndrome is based on a similar occurrence .

Symptoms

The decreased oxygen supply in the affected arm leads to ischemic pain. The central drop in blood pressure can lead to temporary dizziness, ataxias (unsteady gait), visual disturbances and fainting ( syncope ).

Diagnosis

Among the imaging modalities, CT , MRI, and cerebral angiography can be used to diagnose the disease. The duplex ultrasound to assess the carotid artery, subclavian and vertebral arteries is best suited for the diagnosis of the syndrome.

Differential diagnostics

The congenital subclavian steal sequence must be distinguished .

therapy

If the symptoms are severe, dilatation of the stenosis using a balloon catheter ( balloon dilatation ) or a bypass operation can be considered.

literature

  • TJ Takach et al: Myocardial thievery: the coronary-subclavian steal syndrome. Ann Thorac Surg . 2006 Jan; 81 (1), pp. 386-392. PMID 16368420 . Review article.
  • JK Aithal, M. Ulrich: Images in clinical medicine. Subclavian steal syndrome. N Engl J Med . 2010 Sep 2; 363 (10), p. E15. PMID 20830823 . Case report and angiography presentation.
  • Reinhard Larsen: Anesthesia and intensive medicine in cardiac, thoracic and vascular surgery. (1st edition 1986) 5th edition. Springer, Berlin / Heidelberg / New York et al. 1999, ISBN 3-540-65024-5 , p. 439 ( subclavian steal syndrome ).

Individual evidence

  1. ^ Subclavian Steal Syndrome . Retrieved August 21, 2015.