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A D V E R T I S E M E N T
A D V E R T I S E M E N T
A 52-year-old roofer presented with exercise intolerance in his left arm. His symptoms were progressive over a six-month period, and he had recently begun to experience ataxia (see cerebral anatomy). On physical examination, the left brachial and radial pulses were absent. Blood pressures were 110/70 in the left arm and 140/71 on the right. No tissue loss was noted. This aortic arch and four-vessel cerebral arteriogram was obtained. The left subclavian artery is occluded at its origin. Selective injection of contrast into the right vertebral artery revealed a patent Circle of Willis, with cross-filling into the left vertebral artery.
A D V E R T I S E M E N T
Subsequent views demonstrated retrograde vertebral flow into the left subclavian artery distal to the occluded segment. No other clinically significant extracranial lesions were identified. A diagnosis of left subclavian steal syndrome was made, and the patient was prepared for a left common carotid to subclavian artery bypass.
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A D V E R T I S E M E N T
Subclavian steal occurs when there is a stenosis or occlusion of the subclavian artery proximal to the vertebral artery (see neck anatomy). On the right, stenosis or occlusion of the innominate artery can also produce subclavian steal symptoms.
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This page was last modified on 6/30/2000.
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