Subclavian steal syndrome

1979 ◽  
Vol 51 (5) ◽  
pp. 641-643 ◽  
Author(s):  
George L. Bohmfalk ◽  
Jim L. Story ◽  
Willis E. Brown ◽  
Arthur E. Marlin
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Subclavian Steal Syndrome ◽  
Flow Rates ◽  
Content Type ◽  
Subclavian Steal ◽  
Before And After ◽  
Antegrade Flow ◽  
Steal Syndrome

✓ Intraoperative vertebral artery blood flow was measured in two patients with symptomatic subclavian steal syndrome, before and after proximal end-to-side vertebral to common carotid artery transposition. This confirmed retrograde flow in the vertebral artery before transposition, and antegrade flow after transposition. The measured flow rates were compared to values in other series involving different operative procedures for correction of symptomatic subclavian steal. The greatest mean antegrade flow rates in the vertebral artery were restored by proximal end-to-side vertebral to common carotid artery transposition.

Subclavian steal syndrome

1979 ◽  
Vol 51 (5) ◽  
pp. 628-640 ◽  
Author(s):  
George L. Bohmfalk ◽  
Jim L. Story ◽  
Willis E. Brown ◽  
Arthur E. Marlin
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Upper Extremity ◽  
Common Carotid Artery ◽  
Subclavian Steal Syndrome ◽  
Artery Ligation ◽  
Subclavian Steal ◽  
The Brain ◽  
Steal Syndrome

✓ Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition. Neurological symptoms were relieved or improved in all three, with no decrease in blood pressure or pulse in the ipsilateral upper extremity. The colorful history of this syndrome is reviewed, and the various surgical approaches to its treatment are discussed. Although the literature suggests that the commonly used carotid to subclavian artery bypass graft and other similar extrathoracic procedures are generally safe and effective for relief of symptoms of the steal, there is also evidence that these bypasses may fail to restore antegrade flow in the vertebral artery, and, in fact, may steal from the carotid artery. Thus, the blood flow provided to the brain by these procedures may be hardly more than that provided by vertebral artery ligation, whereas the principal effect is to restore blood flow into the upper extremity. Vertebral artery ligation alone has been used in 20 patients, with neurological improvement in all cases and production of persistent intermittent brachial claudication in only one. These considerations and our patient experience suggest that a relatively simple operation, proximal vertebral to common carotid artery transposition, which emphasizes restoration of flow to the brain rather than to the upper extremity, may be preferable for most patients with neurological symptoms of subclavian steal syndrome.

scholarly journals Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Suture Technique ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Bypass Patency ◽  
Patient Consent

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA > 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome

2020 ◽  
Vol 11 ◽  
pp. 419
Author(s):  
Vivek Murumkar ◽  
Shumyla Jabeen ◽  
Sameer Peer ◽  
Aravinda Hanumanthapura Ramalingaiah ◽  
Jitender Saini
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Subclavian Steal Syndrome ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Subclavian Artery Occlusion ◽  
Retrograde Filling ◽  
Vertebrobasilar Junction ◽  
Steal Syndrome

Background: Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description: A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion: Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.

scholarly journals A clampless anastomosis technique using the aortic cannula mounted by a prosthetic graft for a severely calcified aorta in a patient with subclavian steal syndrome

2019 ◽  
Vol 56 (5) ◽  
pp. 1018-1020
Author(s):  
Kohei Sumi ◽  
Shigehiko Yoshida ◽  
Yoshitaka Okamura ◽  
Hideki Kunimoto
Keyword(s):  
High Risk ◽  
Vertebral Artery ◽  
Prosthetic Graft ◽  
Embolic Stroke ◽  
Subclavian Steal Syndrome ◽  
Surgical Strategies ◽  
Subclavian Steal ◽  
Aortic Cannula ◽  
Calcified Aorta ◽  
Steal Syndrome

Abstract Patients with severely calcified aorta are at high risk of embolic stroke during surgery and it is not feasible to clamp the aorta, necessitating alternative surgical strategies. We present a clampless anastomosis technique using the aortic cannula mounted by a prosthetic graft for a severely calcified aorta in a patient with subclavian–vertebral artery steal syndrome.

scholarly journals Endovascular Treatment in the Subclavian Steal Syndrome: Series of 29 Patients

2021 ◽  
Author(s):  
Luana Antunes Maranha Gatto ◽  
Diego do Monte Rodrigues Seabra ◽  
Gabriel Angelo Garute Zenatti ◽  
Letícia Frose ◽  
Gelson Luis Koppe ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Incidental Finding ◽  
Subclavian Steal Syndrome ◽  
Retrograde Flow ◽  
Subclavian Steal ◽  
Brachiocephalic Trunk ◽  
Cerebrovascular Risk ◽  
Steal Syndrome ◽  
Intracranial Circulation ◽  
Angiographic Diagnosis

AbstractSubclavian steal syndrome is a group of symptoms resulting from retrograde flow in the vertebral artery, “stealing” blood from the posterior intracranial circulation and other territories, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the same vertebral artery, or even of the brachiocephalic trunk. Most of the time, it is an incidental finding in patients with other conditions or cerebrovascular risk factors. We report a series of 29 patients with an angiographic diagnosis, in which 7 received treatment (all endovascular), all with symptoms directly related to this condition. Advanced age, systemic arterial hypertension, diabetes mellitus, smoking and stroke were comorbidities frequently related. Six patients improved completely after the procedure and one remained with vertigo.

scholarly journals Vertebral Artery to Common Carotid Artery Transposition: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E198-E198
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Video Recording ◽  
Artery Stenosis ◽  
Front Wall ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Steal Syndrome ◽  
V1 Segment

Abstract Vertebral artery (V1 segment) transposition is a useful technique in the treatment of patients with either proximal subclavian artery stenosis with vertebral “steal” syndrome or severe vertebral artery origin stenosis. This patient required extracranial augmentation of right vertebral artery blood flow to treat proximal vertebral artery stenosis. This was achieved through a V1 to common carotid artery end-to-side anastomosis. The end-to-side anastomosis was performed with the first stitch after the heel stich placed to the inside of the vessel, and the back wall was run from the inside. The anastomosis was completed by running along the front wall from the external surface of the arteries. The anastomosis was flushed by temporary removal of the proximal carotid artery clamp. The anastomotic suture was then tied, and clamps were removed. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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