Subclavian steal

We present two cases of surgical treatment of patients with coronary artery steal syndrom and multifocal atherosclerosis, who previously underwent coronary artery bypass grafting using left internal mammary artery. In both cases carotid-subclavian bypass was performed through supraclavicular access using synthetic prosthesis. This method allowed to restore blood flow in the left internal mammary artery, eliminate recurrent angina pectoris, and improve patients quality of life. The article also contains descriptions of possible methods of surgical correction of this pathology, their advantages and disadvantages...

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BACKGROUND: Symptomatic innominate artery stenosis as hemodynamic bilateral cerebral ischemia is uncommon. We present a rare case of an innominate artery origin severe stenosis and bilateral internal carotid artery (ICA) severe stenosis, inducing hemodynamic cerebral ischemia after ipsilateral axillary artery-bilateral femoral artery bypass, and treated with stent replacement of innominate artery and right ICA. CASE REPORT: A 64-year-old female, who had received previously right axillary artery-bilateral femoral artery anastomosis for abdominal aorta high obstruction, had been suffered from chronic dizziness, so visited our department...

BACKGROUND: Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE: This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION: Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention...

Literature data on the etiology, clinical picture, diagnostic variants and treatment of subclavian steal syndrome are reviewed. Different clinical variants and neurological symptoms of the syndrome are described. Multispiral computed tomography, along with ultrasound examination, is important in the diagnosis of the syndrome and its causes. The use of other methods is necessary for more accurate diagnosis and prevention of perioperative complications. The character of damage of subclavian arteries and brachiocephalic stem should be taken into account in the choice of an optimal method of surgical treatment...

A 77-year-old woman with arteriovenous shunt for hemodialysis in the left forearm suffered from subarachnoid hemorrhage due to the rupture of a saccular aneurysm located on the left lateral wall of vertebrobasilar junction. Her left subclavian artery was severely stenosed and subclavian steal phenomenon was demonstrated on the digital subtraction angiography. Embolization of the parent artery including the aneurysm using detachable coils resulted in the successful obliteration of the aneurysm through the revascularized left subclavian artery...

Chronic obstructive lesions of the subclavian artery (SCA) often result in subclavian steal syndrome, which leads to arm claudication, transient cerebral ischemia, and other serious complications. The lesions are classified as stenosis and occlusion, according to the degree of obstruction. Unlike totally occlusive lesions, including ostial occlusions, stenotic lesions have an excellent technical success rate. In the present study, ostial occlusions were classified into 4 types according to their angiographic appearance...

OBJECTIVES: Our goal was to report the selection schemes, technical variations and long-term outcome of extra-anatomical bypass to correct complex, recurrent aortic coarctation and hypoplastic aortic arch. METHODS: Between 1989 and 2012, 53 patients (mean age 13.2 ± 4.3, median 11.6, range 9-23 years) with complex aortic coarctation ( n  = 33; long-segment hypoplastic aortic arch in 15), recurrent coarctation ( n  = 20; anastomosic pseudoaneurysm in 10), underwent correction using extra-anatomical bypass, either with ( n  = 18: femoral bypass = 13, left heart bypass = 5) or without ( n  = 35) extracorporeal circulation via a left lateral thoracotomy ( n = 48) and combined median sternotomy and median laparotomy ( n  = 5)...

We presented a case of subclavian steal syndrome which has been evaluated and treated quantitatively by using fractional flow reserve technique. Treatment strategy to resolve symptoms of angina in patients with steal syndrome is controversial. Quantitative evaluation should direct choice of treatment strategy.

BACKGROUND: The right-sided aortic arch (RAA) is a rare congenital defect of the aorta. The aim of the study was to assess the occurrence of RAA in diagnoses performed by the University Radiology Department and analyze the frequency of concomitant vascular abnormalities. METHODS: The database of the Radiology Department was retrospectively analyzed between January 2008 and May 2016 with the keyword "right aortic arch". Twenty patients with this diagnosis were identified from a total of 11,690 CT examinations of the chest area, 19,623 CT examinations of brain-supplying vessels, and 1863 MRI examinations of the heart and aortic arch or brain-supplying arteries...

The clinical benefits of using the left internal mammary artery (LIMA) to bypass the left anterior descending artery are well established making it the most frequently used conduit for coronary artery bypass surgery (CABG). Coronary subclavian steal syndrome (CSSS) occurs during left arm exertion when (1) the LIMA is used during bypass surgery and (2) there is a high grade (≥75%) left subclavian artery stenosis or occlusion proximal to the ostia of the LIMA resulting in "stealing" of the myocardial blood supply via retrograde flow up the LIMA graft to maintain left upper extremity perfusion...

Atherosclerotic subclavian artery disease is detected in about 5% of patients referred for coronary artery bypass (CABG) surgery. The internal mammary artery, a branch of the subclavian artery, is the most frequently utilized graft to restore coronary circulation because of its longevity. Stenosis or occlusion of the subclavian artery can cause retrograde blood flow in the ipsilateral internal mammary artery, known as "steal," compromising coronary circulation supplied by the graft. Steal may be asymptomatic or may result in symptoms of myocardial ischemia...

To determine the risk of stroke in patients with subclavian steal syndrome (SSS). We identified 165 patients with imaging-provenSSS from two hospitals. Demographic, clinical and imaging data were retrospectively collected. Patients were followed up for stroke events. Stroke occurred in 43 patients with a median follow-up of 28months. Seven of these cases were identified prospectively and 36 cases retrospectively. On multivariate analysis, presence of symptoms at presentation (p=0.029) was a significant predictor of stroke...

In this paper, we present a numerical study of the pulsatile transitional flow crossing a severe real stenosis located right in front of the bifurcation between the right subclavian and right common carotid arteries. The simulation allows one to determine relevant features of this subject-specific flow, such as the pressure waves in the right subclavian and right common carotid arteries. We explain the subclavian steal syndrome suffered by the patient in terms of the drastic pressure drop in the right subclavian artery...

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OBJECTIVES: To evaluate the safety and feasibility of subclavian artery stenting for coronary-subclavian steal syndrome (CSSS). BACKGROUND: CSSS is a rare cause of myocardial ischemia due to ipsilateral subclavian artery stenosis in patients who have undergone coronary artery bypass graft. However, current knowledge of the optimal therapy for CSSS is limited. METHODS: The clinical data of 37 patients (33 male; mean age 65 ± 6 years) with CSSS who had undergone subclavian artery stenting between April 2007 and December 2015 were analyzed...

BACKGROUND: The status of the left arm, the need of revascularization, and the occurrence of type II endoleakes from de left subclavian artery (LSA) after intention LSA coverage for thoracic aortic aneurysm endovascular repair need to be better understood. This systematic review was developed for contributing with such issue. METHODS: Systematic literature review of studies published from January 2000 through December 2015 identified 7 studies comprising 201 patients submitted to elective endovascular repair for thoracic aortic aneurysms requiring intentional LSA coverage...

No abstract text is available yet for this article.

In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However, in patients with previous coronary artery bypass graft operation (CABG) using internal mammary artery grafts, great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery (LIMA) graft in both cases...

Subclavian artery stenosis is associated with increased cardiovascular disease mortality. It remains an important treatable cause of upper extremity, brain and cardiac ischemia. Endovascular treatment with angioplasty and stenting has become the preferred modality of treatment. Surgical revascularization is reserved for difficult cases with unfavorable anatomy to endovascular approach. Here we describe a case of subclavian artery stenosis causing subclavian steal syndrome with unfavorable anatomy to stenting treated successfully with drug coated balloon angioplasty with maintenance of patency at 6months...