Information about Subclavian Steal Syndrome
| ICD-10 | G45.8 |
|---|---|
| ICD-9 | 435.2 |
| DiseasesDB | 31525 |
| MeSH | D013349 |
Pathophysiology
Classically, SSS is a consequence of a redundancy in the circulation of the brain[1][2] and hemodynamics (the physics of blood flow).SSS results when the short low resistance path (along the subclavian artery) becomes a high resistance path (due to narrowing) and blood flows around the narrowing via the arteries that supply the brain (left and right vertebral artery, left and right internal carotid artery). The blood flow from the brain to the upper limb in SSS is considered to be stolen as it is blood flow the brain must do without.
As in vertebral-subclavian steal, coronary-subclavian steal may occur in patients who have received a coronary artery bypass graft using the internal thoracic artery (ITA).[3] As a result of this procedure, the distal end of the ITA is diverted to one of the coronary arteries (typically the LAD), facilitating blood supply to the heart. In the setting of increased resistance in the proximal subclavian artery, blood may flow backward away from the heart along the ITA causing myocardial ischemia. Vertebral-subclavian and coronary-subclavian steal can occur concurrently in patients with an ITA CABG.[4]
Hemodynamics
Blood, like electrical current, flows along the path of least resistance. If blood is presented with two paths a short one that is very narrow (with a high overall resistance) and a long one that is wide (with a low overall resistance) it will take the long and wide path (the one with the lower resistance).Vascular anatomy
The blood vessels supplying the brain arise from the vertebral arteries and internal carotid arteries and are connected to one another by communicating vessels that form a circle (known as the cerebral arterial circle).Path of the blood (normal versus SSS)
Normally, blood flow from the aorta into the subclavian artery and then some of that blood leaves via the vertebral artery to supply the brain.In SSS a reduced quantity of blood flows through the proximal subclavian artery. As a result, blood travels up one of the other blood vessels to the brain (the other vertebral or the carotids) goes around the cerebral arterial circle and via the (ipsilateral) vertebral artery to the subclavian (with the proximal blockage) and feeds blood to the distal subclavian artery (which supplies the upper limb and shoulder).
Etiology
Signs and symptoms
- Presyncope (sensation that one is about to faint)
- Syncope (fainting)
- Neurologic deficits
- Blood pressure differential between the arms
Differential diagnosis
Diagnostic tests
- Doppler ultrasound
- CT angiography
- Angiogram
Treatment
- Stenting and balloon angioplasty
- Endartertectomy
See also
References
1. ^ Klingelhöfer J, Conrad B, Benecke R, Frank B (1988). "Transcranial Doppler ultrasonography of carotid-basilar collateral circulation in subclavian steal.". Stroke 19 (8): 1036-42. PMID 3041649.
2. ^ Lord R, Adar R, Stein R (1969). "Contribution of the circle of Willis to the subclavian steal syndrome.". Circulation 40 (6): 871-8. PMID 5377222.
3. ^ Takach T, Reul G, Cooley D, Duncan J, Livesay J, Ott D, Gregoric I (2006). "Myocardial thievery: the coronary-subclavian steal syndrome.". Ann Thorac Surg 81 (1): 386-92. PMID 16368420.
4. ^ Lee S, Jeong M, Rhew J, Ahn Y, Na K, Song H, Bom H, Cho J, Ahn B, Park J, Kim S, Kang J (2003). "Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome.". Circ J 67 (5): 464-6. PMID 12736489.
2. ^ Lord R, Adar R, Stein R (1969). "Contribution of the circle of Willis to the subclavian steal syndrome.". Circulation 40 (6): 871-8. PMID 5377222.
3. ^ Takach T, Reul G, Cooley D, Duncan J, Livesay J, Ott D, Gregoric I (2006). "Myocardial thievery: the coronary-subclavian steal syndrome.". Ann Thorac Surg 81 (1): 386-92. PMID 16368420.
4. ^ Lee S, Jeong M, Rhew J, Ahn Y, Na K, Song H, Bom H, Cho J, Ahn B, Park J, Kim S, Kang J (2003). "Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome.". Circ J 67 (5): 464-6. PMID 12736489.
External links
- Subclavian Steal Syndrome - emedicine.com
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The term symptom (from the Greek σύμπτωμα meaning 'chance', 'mishap' or 'casualty', itself derived from συμπιπτω
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The vertebral arteries are branches of the subclavian arteries.
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Cervical
They arise, one on each side of the body, then enter deep to the transverse process of the level of the 6th cervical vertebrae (C6)...... Click the link for more information.
Blood is a specialized biological fluid consisting of red blood cells (also called RBCs or erythrocytes), white blood cells (also called leukocytes) and platelets (also called thrombocytes) suspended in a complex fluid medium known as blood plasma.
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In human anatomy, the internal thoracic artery (ITA), previously known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts.
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In sciences dealing with the anatomy of animals, precise anatomical terms of location are necessary for a variety of reasons. Non-scientists often wonder why zoological and human anatomists use complex terminology to describe locations on a body, when common terms like "up",
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In human anatomy, the subclavian artery is a major artery of the upper thorax that mainly supplies blood to the head and arms. It is located below the clavicle, hence the name. There is a left subclavian and a right subclavian.
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A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. It is also sometimes called a "stricture" (as in urethral stricture).
Stenoses of the vascular type are often associated with a noise (bruit) resulting from turbulent flow over the
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Stenoses of the vascular type are often associated with a noise (bruit) resulting from turbulent flow over the
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Hemodynamics, meaning literally "blood movement", is the study of blood flow or the circulation.
All animal cells require oxygen (O2) for the conversion of carbohydrates, fats and proteins into carbon dioxide (CO2), water and energy in a process known as aerobic respiration.
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All animal cells require oxygen (O2) for the conversion of carbohydrates, fats and proteins into carbon dioxide (CO2), water and energy in a process known as aerobic respiration.
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Physics is the science of matter[1] and its motion[2][3], as well as space and time[4][5] —the science that deals with concepts such as force, energy, mass, and charge.
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In human anatomy, the upper limb (also upper extremity) refers to what in common English is known as the arm, that is, the region of the shoulder to the fingertips. It includes the entire limb, and thus, is not synonymous with the term upper arm.
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The term steal can mean either:
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- To commit theft
- In baseball, to gain a stolen base
- In basketball, a steal occurs when the defensive player actively takes possession of the ball from the opponent's team
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The coronary circulation is the circulation of blood in the blood vessels that supply blood to and from the heart muscle itself. Although blood fills the chambers of the heart, the muscle tissue of the heart, or myocardium, is so thick that it requires coronary blood vessels to
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Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease.
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In human anatomy, the internal thoracic artery (ITA), previously known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts.
..... Click the link for more information.
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The "LAD", or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) is an artery of the heart.
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heart is a muscular organ responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in the annelids, mollusks, and arthropods.
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MeSH D017202 Ischaemic (or ischemic) heart disease, or myocardial ischemia, is a disease characterized by reduced blood supply to the heart. It is the most common cause of death in most western countries.
Ischaemia means a "reduced blood supply".
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Ischaemia means a "reduced blood supply".
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The coronary circulation is the circulation of blood in the blood vessels that supply blood to and from the heart muscle itself. Although blood fills the chambers of the heart, the muscle tissue of the heart, or myocardium, is so thick that it requires coronary blood vessels to
..... Click the link for more information.
..... Click the link for more information.
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease.
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Electric current is the flow (movement) of electric charge. The SI unit of electric current is the ampere (A), which is equal to a flow of one coulomb of charge per second.
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The blood vessels are part of the cardiovascular system and function to transport blood throughout the body. The most important types, arteries and veins, carry blood away from or towards the heart, respectively.
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In animals, the brain or encephalon (Greek for "in the skull"), is the control center of the central nervous system, responsible for behavior. The brain is located in the head, protected by the skull and close to the primary sensory apparatus of vision, hearing,
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The vertebral arteries are branches of the subclavian arteries.
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Cervical
They arise, one on each side of the body, then enter deep to the transverse process of the level of the 6th cervical vertebrae (C6)...... Click the link for more information.
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