Symptomatology of the Subclavian Steal Syndrome

Abstract

The subclavian steal syndrome, at first angiographically observed by Co-torni7 in 160, and according to clinical experiments determined by Reivich et a1.2 in 1961, has expectedly gained practical importance in the past years. Up to now we have noticed some 203 publications and 386 cases described in the Anglo-American as well as German and French literature, of which information was given lately in a comprehensive summary.3 Up to now, the German literature has published some 27 compositions on subclavian steal syndrome and reported on 97 cases (table 1). In the Anglo-American literature, comparable summary reports were submitted by Patel and Toole, 29 Killen et al.,3° Santschi et a1.31 and Solnitzky.32 Recently, Labauge et al.33 also published results of an important case analysis.A subclavian steal syndrome is to be understood as an occlusion or a stenosis of the initial part of a subclavian artery situated before the origin of the vertebral artery or of the a. innominata (tr. brachiocephalicus) in connection with a retrograde blood circulation of the reciprocal vertebral artery ( fig. 1). The return of the vertebral circulation is induced by a poststenotic fall of blood pressure in the peripheral subclavian artery and leads to a decrease of the cerebral circulation power, the so-called &dquo;steal&dquo; or &dquo;syphoning&dquo; effect. The size of this steal volume is variable with physical rest as well as under burden, and subject to the extent of the pre-to postvertebral incline of pressure, of luminary space of the vertebral artery and finally of the presence of further closes or stenosis on other intra-and extracerebral vessels.The most frequent cause of a subclavian steal syndrome is arterial sclerotic variabilities, while least of all congenital aplasia or atresia, traumatic stenosis, operative steal syndromes according to Blalock-Taussig and Claget operations and embolisms are taken as a basis.According to our analysis,3 there are observed about two to three times more men than women out of 207 cases with the subclavian steal syndrome. The climax of frequency of this illness lies between the 50th and 55th years of age at either sex (men: 52.3 years of age; women: 49.0 years of age) corresponding to the most arteriosclerotic genesis of the state of disease. The left subclavian artery is about 2 to 2.5 times more often attacked than the right one combined with innominata ( fig. 1). Bilateral subclavian steal syndromes occur by about 1 to 2 per cent. Out of 89 cases, 77 per cent suffered from a total stop and 23 per cent from a stenosis, and out of 97 cases, 53 per cent suffered from

A review of subclavian steal syndrome with clinical correlation

“…Angiography was the initial test used to screen for subclavian steal, with only high probability patients being investigated [6]. This selection bias in testing gave the false impression that SSS was not only rare, but also symptomatic [7].…”

The Steal Syndromes

“…The average age of patients with subclavian steal is 50-60 years (46,47) and there is a predominance in men (70%). The subclavian steal also occurs three times more often on the left side (47).…”

“…About 77% of all patients suffer from occlusion and about 23% from stenosis. Of the total, about one half suffer from multiple vascular occlusions or stenoses (46,47) and 10% are hypertensive. Spontaneous improvement may occur in many cases (8), apparently due to the development of adequate collaterals.…”

Can Subclavian Steal Simulate Angina Pectoris?

“…Tyras and Barney' 1 thus suggested that systolic pressure gradients of 60 mm Hg or greater are more commonly seen in symptomatic patients,11 but other series describe similar symptoms with systolic pressure gradients as low as 20 mm Hg. 35,36 In order to provide convincing documentation of our hypothesis, arteriograms must be made with good visualization of the internal mammary arteries and note made of direction of flow both at rest and during arm exercise. Full cardiologic evaluation must, of course, include arm3' as well as leg exercise EKG.…”