Iatrogenic Subclavian Steal Syndrome

Subclavian steal syndrome

BACKGROUND

Subclavian steal syndrome is a systemic entity that is well-documented in the medical literature. It occurs when the subclavian artery becomes stenosed or occluded and blood flow is reversed in the ipsilateral vertebral artery. This siphoning or "stealing" of blood has traditionally been thought to cause symptoms of vertebral-basilar insufficiency. Recent literature indicates that subclavian steal syndrome is often asymptomatic, but may be associated with a wide variety of signs and symptoms of vertebro-basilar, carotid, or upper extremity ischemia, and that the manifestation of the condition is probably dependent on the patency of the other cranial arteries.

CASE REPORTS

This report describes three patients who underwent comprehensive eye examinations and who had been previously diagnosed with subclavian steal phenomenon. The initial symptoms included: unilateral Hollenhorst plaque, unilateral fibrino-platelet plaque, and one patient with no symptoms These patients were followed for their ocular conditions concurrently with their physicians following their systemic circulatory disease. Signs and symptoms, imaging and laboratory tests, and management are discussed.

CONCLUSIONS

Subclavian steal syndrome is a systemic condition that may manifest ocular signs and symptoms that optometrists should recognize, and which merits referral for systemic evaluation and treatment as necessary Patients who manifest signs and symptoms of vertebro-basilar insufficiency, carotid territory ischemia, or ocular symptoms of atherosclerosis may be diagnosed with subclavian steal syndrome as evaluation of the extracranial arteries is pursued.