MedUNAB (Aug 2006)
Subclavian steal syndrome. Case presentation diagnostic approach and treatment
Abstract
The subclavian steal syndrome is due to a proximal estenosis ofthe subclavian artery that leads to a retrograde flow in the ipsilateral vertebral artery that acts as a collateral. Isquemia affects the brain and the upper limb of the estenotic side causing neurological symptoms, although the greater percentage of these patients are asymptomatic since the circle of Willis permits a suitable collateral circulation. The first step after the clinical suspicion of this syndrome, is to perform a Doppler ultrasound of the vessels of the neck whichfinds a retrograde flow of the vertebral artery, this is confirmed by an angiography which demonstrates the inversion of flow of the vertebral artery and the proximal estenosis of the subclavia. Once the diagnosis is confirmed an angioplasty with an stent placement is indicated yielding a permeability of 90% in three years. Other diagnostic techniques used are multidetector CT and magnetic resonance both with three-dimensional reconstruction of images.
