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Barkyoumb D, Kharbat AF, Orenday-Barraza JM, Pahuja M, Shakir HJ. Transradial stenting of left subclavian artery origin using shockwave intravascular lithotripsy balloon plasty: Technical report and literature review. Interv Neuroradiol 2024:15910199241260076. [PMID: 38853685 DOI: 10.1177/15910199241260076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Lesions of the subclavian artery often involve pathologic stenosis due to high degrees of calcification within the vessel wall. While endovascular angioplasty and stenting is generally the preferred method for obtaining flow reconstitution, calcification of the vessel wall has proven to significantly impair the efficacy of successful stent deployment. Shockwave intravascular lithotripsy (IVL) is a technology that has been very successful in addressing this challenge in other vascular territories, however its use has yet to be approved for supra-aortic vessels such as the subclavian artery. In this report, the use of IVL for a case of subclavian steal syndrome due to a highly stenosed left subclavian artery is described along with a review of the literature. Although several cases utilizing this technology in subclavian arteries have been reported, none have described the use of a left transradial approach. Therefore the purpose of this report is to demonstrate the efficacy of IVL for supra-aortic vessels so that its benefits can be expanded to a broader patient population.
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Affiliation(s)
- David Barkyoumb
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abdurrahman F Kharbat
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Mohit Pahuja
- Section of Cardiovascular Diseases, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hakeem J Shakir
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Vinod P, Patel H. A Novel Case of Anomalous Origin of Left Vertebral Artery Associated With Left Subclavian Steal Syndrome. Cardiol Res 2024; 15:205-209. [PMID: 38994224 PMCID: PMC11236351 DOI: 10.14740/cr1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024] Open
Abstract
The subclavian steal syndrome (SSS) is defined by the reversal of flow in the ipsilateral vertebral artery in the setting of subclavian artery stenosis proximal to its origin. Here, we describe a rare case of left SSS with significant left subclavian artery stenosis associated with anomalous origin of the left vertebral artery (LVA) directly from the aortic arch in a patient presenting with signs of vertebrobasilar insufficiency and resolution of symptoms following angioplasty. Through this case, the authors try to emphasize the importance and the correct technique of using Doppler ultrasonography, and the importance of invasive angiography in understanding the mechanism of subclavian steal in patients with anomalous LVA origin.
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Affiliation(s)
- Poornima Vinod
- Department of Internal Medicine, University of North Carolina Health at Southeastern, Lumberton, NC 28358, USA
| | - Hiten Patel
- Division of Interventional Cardiology, University of North Carolina Health at Southeastern, Lumberton, NC 28358, USA
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Zhang L, Wang L, Yan Y, Tao Q, Gu X. Relationship Between Subclavian Artery Stenosis Lesions and Posterior Circulation Infarction: A Preliminary Study. Ann Vasc Surg 2024; 108:195-205. [PMID: 38821478 DOI: 10.1016/j.avsg.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/03/2024] [Accepted: 03/23/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND To investigate the correlation between subclavian steal syndrome and posterior circulation infarction using magnetic resonance imaging. METHODS A total of 294 patients diagnosed with subclavian steal syndrome using carotid Doppler ultrasonography were retrospectively included. According to the magnetic resonance imaging results, they were divided into posterior circulation infarction group and nonposterior circulation infarction group. Clinical indicators and carotid Doppler ultrasound parameters of patients were collected, and they were screened to establish a multiple logistic regression model. Receiver operating characteristic curve analysis of the established multiple logistic regression model was performed, and the area under the curve was calculated to evaluate the predictive efficiency of the model. RESULTS After statistical analysis of all parameters of the 2 groups of patients, a total of 10 parameters were included in multiple logistic regression to establish a model. The results showed a correlation between posterior circulation infarction and subclavian artery occlusion, grade III subclavian steal syndrome, gender, vulnerable plaques, National Institutes of Health Stroke Scale score, and age. After the receiver operating characteristic curve analysis of the model, the area under the curve for the multiple logistic regression model was 0.773. CONCLUSIONS The multiparameter composite model based on clinical baseline data and carotid Doppler ultrasonography parameters can effectively predict posterior circulation infarction and offer novel insight for clinical diagnosis.
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Affiliation(s)
- Lingyan Zhang
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China
| | - Lei Wang
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China
| | - Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Tao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxian Gu
- Department of Ultrasound, The Fourth Affiliated of Soochow University, Suzhou, China.
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Takahara M, Murakami T, Toyota S, Okuhara S, Touhara K, Hoshikuma Y, Achiha T, Yamada S, Kobayashi M, Kishima H. A Case of Pontine Infarction due to Subclavian Steal Phenomenon Enhanced by an Arteriovenous Shunt for Hemodialysis. NMC Case Rep J 2024; 11:145-150. [PMID: 38911923 PMCID: PMC11190656 DOI: 10.2176/jns-nmc.2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/15/2024] [Indexed: 06/25/2024] Open
Abstract
We present a case of pontine infarction caused by subclavian steal phenomenon (SSP) due to subclavian artery stenosis (SAS) and an arteriovenous shunt in the forearm in a 74-year-old man with hemodialysis and stenting for SAS with improvement of SSP. He developed dysarthria during dialysis. He was admitted to our hospital and diagnosed with a pontine infarction. As the basilar artery appeared to be occluded on magnetic resonance angiography, an emergency diagnostic angiography was performed. Aortagram showed severe stenosis of the left subclavian artery. Right vertebral artery (VA) angiogram revealed retrograde arterial blood flow from the right VA to the left VA via the VA union, which suggested SSP. In addition, the steal was augmented by an ipsilateral hemodialysis arteriovenous shunt. Percutaneous subclavian artery stenting was performed 12 days later, and there was no recurrence of symptoms in the follow-up period. To our knowledge, this study is the first to report a patient with SSP who developed a pontine infarction due to SAS and an arteriovenous shunt during hemodialysis and who underwent subclavian artery stenting and had a good outcome.
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Affiliation(s)
- Motohide Takahara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shuki Okuhara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kazuhiro Touhara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yuhei Hoshikuma
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takamune Achiha
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shuhei Yamada
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Maki Kobayashi
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
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Mansour M, Raffoul L, Alattar O, Deeb H, Albainy L, Taqem S. Subclavian steal syndrome: a case study of diagnosis, management, and successful surgical resolution. J Surg Case Rep 2024; 2024:rjae280. [PMID: 38706487 PMCID: PMC11068443 DOI: 10.1093/jscr/rjae280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention.
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Affiliation(s)
- Marah Mansour
- Faculty of Medicine, Tartous University, 8th March street, 7th project, Tartous, Syrian Arab Republic
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW Rochester, MN 55905, United States
| | - Lutfallah Raffoul
- Faculty of Medicine, Al Andalus University for Medical Sciences, Al-Qadmus street, Tartous, Syrian Arab Republic
| | - Omar Alattar
- Faculty of Medicine, Damascus University, Fayez Mansour street, Damascus, Syria
| | - Hala Deeb
- Faculty of Medicine, Damascus University, Fayez Mansour street, Damascus, Syria
| | - Laila Albainy
- Department of Plastic Surgery, Al Mujtahid hospital, Khaled Ibn Alwalid street, Damascus, Syria
| | - Saleh Taqem
- Department of Cardiology, Alasad University hospital, 17 April street, Damascus, Syria
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Huang Y, Xie X, Huang G, Lu W, Hong S, Chen Y, Lin Y, Fu W, Hong X, Wang L. Long-term outcomes of endovascular therapy for right subclavian artery occlusive lesions: A multi-center experience. Vascular 2024:17085381241247613. [PMID: 38631687 DOI: 10.1177/17085381241247613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To review our multi-institutional experience with endovascular therapy for right subclavian artery occlusive disease and to evaluate the long-term outcomes. METHODS We retrospectively evaluated all patients with right subclavian artery stenosis and occlusive disease who underwent endovascular therapy between March 2014 and September 2022 at two institutions. Patient baseline demographics, lesion characteristics, treatment strategies, and in-hospital and follow-up outcomes were prospectively collected and retrospectively analyzed. RESULTS Between March 2014 and September 2022, 73 patients underwent endovascular treatment at the two institutions. The dominant cause of lesions in this cohort was atherosclerosis. Three different types of lesions were summarized, and the corresponding endovascular strategies were performed. 66 patients (90.4%) underwent successful endovascular treatment, and 62 patients (84.9%) underwent balloon-expandable stent deployment. The mean perioperative in-hospital stay was 4.0 days (range, 3-6 days). Two patients died due to myocardial infarction, and one died of cerebral hemorrhage resulting from a traffic accident within 30 days of the intervention. The median follow-up time was 31.6 months (range, 12-96 months). No complications, including death, stroke, stent fractures, or migration, were noted in any patient during the follow-up period. The overall complication rate was 7/73 (9.6%), and 5/7 (6.9%) of the complications required reintervention. CONCLUSIONS Endovascular treatment of right subclavian artery lesions is safe, effective, and technically achievable. The reasonable use of balloon-expandable stents can achieve satisfactory outcomes with accurate orientation and promising patency.
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Affiliation(s)
- Yulong Huang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xinsheng Xie
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Guoqiang Huang
- Department of Radiology, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Weifeng Lu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Shichai Hong
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yihui Chen
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yue Lin
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Weiguo Fu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Xiang Hong
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
| | - Lixin Wang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
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Nedelcu AH, Lupu A, Moraru MC, Tarniceriu CC, Stan CI, Partene Vicoleanu SA, Haliciu AM, Statescu G, Ursaru M, Danielescu C, Ioniuc I, Tepordei RT, Lupu VV. Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature. J Pers Med 2024; 14:335. [PMID: 38672962 PMCID: PMC11051064 DOI: 10.3390/jpm14040335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. MATERIALS AND METHODS We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. RESULTS Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges. CONCLUSIONS ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
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Affiliation(s)
- Alin Horatiu Nedelcu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
- Radiology Clinic, Recovery Hospital, 700661 Iasi, Romania
| | - Ancuta Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Marius Constantin Moraru
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristina Claudia Tarniceriu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Cristinel Ionel Stan
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Simona Alice Partene Vicoleanu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Ana Maria Haliciu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Gabriel Statescu
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Manuela Ursaru
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
- Radiology Clinic, “Sf Spiridon” County Clinical Emergency Hospital Iasi, 700661 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgical Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (M.U.); (C.D.)
| | - Ileana Ioniuc
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
| | - Razvan Tudor Tepordei
- Department of Morpho-Functional Science I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (A.H.N.); (C.C.T.); (C.I.S.); (S.A.P.V.); (A.M.H.); (G.S.); (R.T.T.)
| | - Vasile Valeriu Lupu
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (I.I.); (V.V.L.)
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Rolon S, Wood JC, Gableman A, Hieb RA, Rossi PJ, Mansukhani NA. Atypical presentation of subclavian steal syndrome with left sided sensorineural deafness. J Vasc Surg Cases Innov Tech 2023; 9:101308. [PMID: 38034594 PMCID: PMC10684813 DOI: 10.1016/j.jvscit.2023.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/09/2023] [Indexed: 12/02/2023] Open
Abstract
We present a rare manifestation of a common pathology: left sided sensorineural hearing loss secondary to subclavian steal syndrome after thoracic endovascular aortic repair for complicated acute aortic dissection. We describe the vascular physiology that can result in unilateral hearing loss and provide a brief review of subclavian steal syndrome. This case report highlights the importance of avid clinical recognition of an atypical presentation of a common vascular disease.
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Affiliation(s)
- Santiago Rolon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacob C. Wood
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Angela Gableman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert A. Hieb
- Division of Vascular Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter J. Rossi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Neel A. Mansukhani
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hashimoto K, Kawahara T, Miyoshi K, Sato T, Itoh S. A case of carotid-axillary bypass for subclavian steal syndrome in an 83-year-old female undergoing hemodialysis. Int J Surg Case Rep 2023; 112:108974. [PMID: 37922837 PMCID: PMC10667892 DOI: 10.1016/j.ijscr.2023.108974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Patients undergoing hemodialysis exhibit a high incidence of subclavian steal syndrome. Many cases of endovascular treatment for subclavian artery stenosis were only reported recently; however, the long-term results of surgical treatment are also important. Herein, we report a case of subclavian steal syndrome treated with common carotid-axillary bypass surgery in a patient undergoing hemodialysis. PRESENTATION OF CASE An 83-year-old woman experienced dizziness and pain in her left hand during hemodialysis. Computed tomography and angiography revealed severe stenosis and calcified lesions in the left subclavian artery. Ultrasonography revealed a retrograde blood flow waveform in the left vertebral artery. The patient was diagnosed with subclavian steal syndrome. We performed common carotid-axillary bypass for lesions that were difficult to revascularize via endovascular therapy. The post-operative course was uneventful, and the dizziness and numbness in the patient's left hand during dialysis disappeared. Post-operative ultrasonography revealed an antegrade blood flow waveform in the left vertebral artery. DISCUSSION Subclavian steal syndrome is an indication for revascularization in symptomatic patients. Endovascular treatment should be considered the first choice; however, surgery should be considered for patients in whom endovascular treatment is difficult, such as those with severe calcification. We chose common carotid-axillary artery bypass because the subclavian approach is a more familiar technique. Until 1 year post-operatively, the patient had not experienced any symptom recurrence, and the shunt flow was well maintained. CONCLUSION Common carotid-axillary bypass can be useful for revascularization of lesions for which endovascular therapy is considered difficult in patients with subclavian steal syndrome.
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Affiliation(s)
- Kazunori Hashimoto
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Naka-ku, Yokohama, Kanagawa 231-8682, Japan.
| | - Takuya Kawahara
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Naka-ku, Yokohama, Kanagawa 231-8682, Japan
| | - Kosuke Miyoshi
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Naka-ku, Yokohama, Kanagawa 231-8682, Japan.
| | - Tetsuya Sato
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Naka-ku, Yokohama, Kanagawa 231-8682, Japan
| | - Satoshi Itoh
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Naka-ku, Yokohama, Kanagawa 231-8682, Japan.
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Choi HY, Lee S, Park J, Song YJ, Kim DK, Kim KH, Seol SH, Kim DI, Kim S. Endovascular treatment of Takayasu arteritis in a middle-aged woman with syncope and limb claudication: a case report. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:448-453. [PMID: 37098683 PMCID: PMC10626312 DOI: 10.12701/jyms.2023.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 04/27/2023]
Abstract
Takayasu arteritis (TA) is a disease that causes inflammation and stenosis of medium to large blood vessels. We report a case of a 50-year-old female patient with newly developed hypertension, syncope, and claudication of the extremities. Total occlusion of the left subclavian artery at the origin was found and significant stenosis of the right common iliac artery was revealed by hemodynamic analysis. She was successfully treated with percutaneous angioplasty for multiple peripheral arterial diseases and was finally diagnosed with TA. In consultation with a rheumatologist, medical treatment for TA was initiated, the patient's hypertension disappeared, and her claudication symptoms improved.
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Affiliation(s)
- Ha-Young Choi
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sunggun Lee
- Division of Rheumatology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jino Park
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yeo-Jeong Song
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seunghwan Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Zalaquett Z, Zgheib G, Karam L, Zaatar M, Nehme K, Tabet G. A rare association of subclavian steal syndrome with bilateral carotid artery stenosis: a case report. J Vasc Surg Cases Innov Tech 2023; 9:101243. [PMID: 37799832 PMCID: PMC10547741 DOI: 10.1016/j.jvscit.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 10/07/2023] Open
Abstract
Bilateral carotid artery stenosis in the context of subclavian steal syndrome is an extremely rare finding. We report the case of a 75-year-old woman who presented with a transient ischemic attack. Bilateral internal carotid stenosis associated with left subclavian steal syndrome was diagnosed. Left internal carotid endarterectomy was performed under locoregional anesthesia. Inflation of a blood pressure cuff reversed the neurologic symptoms that appeared after internal carotid clamping. This rarely reported case remains a challenge to diagnose and treat because of its complex mechanisms and multiple risk factors. Our case highlights the importance of the surgical strategy adopted and the need for a good initial assessment.
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Affiliation(s)
- Ziad Zalaquett
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Ghady Zgheib
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Lamisse Karam
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Maya Zaatar
- Department of Radiology and Medical Imaging, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Karim Nehme
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Tabet
- Department of Thoracic and Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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12
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Patel DJ, Chaudhari K, Gupta A, Patel N, Patel PP. Navigating Subclavian Artery Stenosis in Pregnancy: A Multidisciplinary Approach to a High-Risk Case. Cureus 2023; 15:e43933. [PMID: 37746358 PMCID: PMC10513350 DOI: 10.7759/cureus.43933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Given the possibility of serious consequences for both the pregnant woman and the developing baby, subclavian artery stenosis (SAS) during pregnancy represents a unique but demanding scenario that requires quick and thorough treatment. In this report, we present a case of a pregnant patient with SAS who was managed effectively by employing a multidisciplinary approach, with a focus on clinical decision-making and intervention measures to ensure the best possible outcomes for both the mother and the fetus. This case report highlights the significance of prompt recognition and action to avoid the adverse consequences of SAS during pregnancy. To establish uniform standards for managing such high-risk cases and achieve better patient outcomes, more research and case studies are required.
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Affiliation(s)
- Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nainita Patel
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pooja P Patel
- Department of Dermatology, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Navi Mumbai, IND
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13
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McCluskey M, Baber P, Rind S, Xu D. Variant of subclavian steal syndrome: unusual anatomical relationship between left subclavian artery and left vertebral artery. BMJ Case Rep 2023; 16:e252966. [PMID: 37185244 PMCID: PMC10151969 DOI: 10.1136/bcr-2022-252966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
A woman in her 70s presented to her general practitioner (GP) with a 3-month history of left upper arm pain and weakness. A significant difference in bilateral blood pressures was noted and a further history elicited coolness in her left arm without functional compromise. A CT angiography revealed variant subclavian steal syndrome with a subclavian arterial stenosis, which was proximal to both the internal mammary and thyrocervical trunk and her left vertebral artery originating from the aortic arch. She was referred to a vascular surgeon but declined surgical intervention. Her symptoms remain stable with 6-month follow-up from her GP. This case highlights the importance of considering vascular aetiologies in upper limb pain and weakness. Our case reviews the differential diagnoses of upper limb pain and weakness, consequently leading to the discussion of an interesting variant of subclavian stenosis.
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Affiliation(s)
- Mia McCluskey
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Peter Baber
- Radiology Department, SKG Radiology, Murdoch, Western Australia, Australia
| | - Shahmir Rind
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Dan Xu
- Curtin Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Medical Education & General Practice, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
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14
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Torere BE, Aiwuyo HO, Rash M, Gerlach G, Russell N, Robinson Dolye A. Subclavian Steal Syndrome as the Initial Presentation of Takayasu's Vasculitis in a Young Caucasian Female. Cureus 2023; 15:e37940. [PMID: 37220439 PMCID: PMC10200268 DOI: 10.7759/cureus.37940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Takayasu arteritis (TAK) is a rare but well-known inflammatory disease affecting large vessels that leads to thickening, narrowing, occlusion, or dilation of the affected arteries. The overall effect of the disease is arterial insufficiency of the brain and/or the distal part of the affected vessel. Subclavian steal syndrome has been observed as a form of presentation where there is occlusion of the proximal subclavian artery that results in a reversal of flow in the ipsilateral vertebral artery, consequently diverting or 'stealing' blood from the contralateral vertebral artery. Our patient is a 34-year-old Caucasian female presenting with subclavian steal syndrome as the initial presentation of TAK. She presented to the emergency department following a syncopal episode and six months prior history of intermittent lightheadedness, vertigo, left upper extremity pain, numbness, and tingling which was said to be aggravated with activity and alleviated with rest. Examination findings revealed non-palpable left brachial and radial pulses of the upper limb with an inaudible blood pressure reading on the ipsilateral side and blood pressure of 113/70 mmHg on the contralateral arm. Investigation revealed elevated acute phase reactant, normocytic anemia, and inflammation of the aorta on imaging. She was evaluated by the vascular surgery team who recommended medical management. The patient was managed with steroids and methotrexate, and her symptoms improved significantly with the normalization of laboratory findings. She is currently being followed up by the vascular surgery and rheumatology teams. We emphasize the importance of understanding the varied clinical spectrum of TAK and the need to have a high index of suspicion for TAK in a young female with recurrent syncope and unilateral upper extremity intermittent numbness and paresthesia.
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Affiliation(s)
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Max Rash
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Gene Gerlach
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Noah Russell
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
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15
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Shankar DS, Rybalko DA, Goldman D, Nowakowski FS, Hausman MR. Applications of Vascular Imaging and Interventional Radiology Modalities in the Upper Extremity: A Review. J Hand Surg Am 2023; 48:165-176. [PMID: 36333243 DOI: 10.1016/j.jhsa.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/30/2022] [Accepted: 09/14/2022] [Indexed: 01/01/2023]
Abstract
Hand and upper extremity (HUE) vascular disorders are encountered frequently by hand surgeons in clinical practice. A wide array of imaging and vascular interventional radiology modalities exists for the diagnosis and treatment of HUE vascular disorders, some of which may not be familiar to the HUE surgeons. In this review article, we summarize the vascular imaging and vascular interventional radiology modalities and their relative advantages, disadvantages, and indications with respect to HUE pathology. We aim to familiarize HUE surgeons with the available types of diagnostic and therapeutic options for HUE vascular pathologies and aid interdisciplinary communication with vascular interventional radiology specialists during the clinical decision-making process.
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Affiliation(s)
- Dhruv S Shankar
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Daryl Goldman
- Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Chiocchi M, Laudazi M, Leomanni P, Giudice L, Madonna M, Garaci F, Floris R. A rare case of symptomatic vascular ring. Radiol Case Rep 2023; 18:957-962. [PMID: 36636482 PMCID: PMC9829553 DOI: 10.1016/j.radcr.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
In this paper, we describe a rare case of double aortic arch with dominant right arch with focal narrowing of the distal left arch and descendent aorta's dilatation, associated with pulmonary embolism and left subclavian steal syndrome, found in a 59-year-old woman with a history of dysphagia, chest discomfort, and left arm claudication. Diagnosis of this condition was made with a sub-optimal pulmonary CT-angiography with a combination of characteristic features of double aortic arch and vascular rings. Being aware of these conditions is crucial to avoid misclassification and surgical and endovascular complications.
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17
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Muacevic A, Adler JR, Kaur P, Das DD, Kondapalli M. Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy. Cureus 2023; 15:e33310. [PMID: 36741643 PMCID: PMC9894333 DOI: 10.7759/cureus.33310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Subclavian steal syndrome (SSS) refers to the phenomenon of retrograde flow in an ipsilateral branch of the subclavian artery due to hemodynamically significant stenosis or occlusion of the ipsilateral proximal subclavian artery. While SSS is usually asymptomatic, it can manifest as vertebrobasilar insufficiency (VBI), ischemia of the affected extremity, or cardiac angina when an internal mammary artery (IMA) is used as a bypass graft. The underlying etiology is most often atherosclerosis but can include Takayasu arteritis, thoracic outlet syndrome, cervical rib, and stenosis secondary to surgical repair of aortic coarctation or tetralogy of Fallot. There are several case reports describing unique presentations of SSS as well as limited reports of double SSS, where the brachiocephalic steno-occlusive disease causes flow reversal in both the ipsilateral vertebral and carotid arteries. We report herein the first documented case, to our knowledge, of a patient with SSS previously treated with left subclavian artery stenting and left common carotid-subclavian bypass who developed recurrent SSS in conjunction with orthostatic cerebral hypoperfusion syndrome (OCHOS) secondary to severe vasculopathy. She presented with recurrent, paroxysmal vertigo and near-syncope associated with left upper extremity paresthesias that would only abate with sitting in the context of left subclavian artery stent restenosis and occlusion of her left common carotid-subclavian bypass graft. Interestingly, her initial presentation entailed retrograde flow from the left vertebral artery to the left subclavian artery, classic for SSS, but recurrence of her SSS involved retrograde flow from the left common carotid artery to the left subclavian artery, a phenomenon which has also not been described in the literature to our knowledge. As her symptoms of VBI appeared to be triggered by standing and not left arm movement, they were considered to be primarily secondary to OCHOS. Consequently, her primary treatment was to increase salt and fluid intake and thus increase intravascular volume for improved cerebral perfusion as she was not deemed to be a suitable candidate for regrafting of the left subclavian artery.
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18
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Burle VS, Panjwani A, Mandalaneni K, Kollu S, Gorantla VR. Vertebral Artery Stenosis: A Narrative Review. Cureus 2022; 14:e28068. [PMID: 36127977 PMCID: PMC9477552 DOI: 10.7759/cureus.28068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Vertebral artery stenosis (VAS) is the cause of approximately 20% of ischemic strokes in the posterior circulation. There are several causes of vertebral artery stenosis, including atherosclerosis, calcification, dissections, fibromuscular dysplasia, giant cell arteritis, neurofibromatosis type 1, and bony compressions. The most common cause of VAS is atherosclerosis which is derived from the macrophage-induced oxidation of low-density lipoproteins (LDLs), alongside the accumulation of cholesterol. Calcification of the vertebral artery occurs when there is excess calcium and phosphate deposition in the vessel. Dissection of the vertebral artery can lead to the formation of a hematoma causing stenosis of the vertebral artery. Fibromuscular dysplasia can result in stenosis due to the deposition of collagen fibers in the tunica media, intima, or adventitia. Giant cell arteritis, an autoimmune disorder, causes inflammation of the internal elastic membrane resulting in eventual stenosis of the artery. Neurofibromatosis type 1, an autosomal dominant disorder, results in the stenosis of the vertebral artery due to the altered function of neurofibromin. Mechanical compression of the vertebral artery by bone can also cause stenosis of the vertebral artery. Digital subtraction angiography (DSA) is considered the current gold standard in diagnosing vertebral artery stenosis; however, its associated morbidity and mortality have led to increased use of non-invasive techniques such as duplex ultrasonography (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). Currently, asymptomatic and symptomatic vertebral artery stenoses are treated by risk factor modification and medical treatment. However, it is recommended that surgical (endarterectomy, reconstruction, and decompression) and endovascular (balloon coronary, bare-metal, and drug-eluting stents) treatments are also used for symptomatic vertebral artery stenosis.
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19
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AbuRahma AF, Santini A, Beasley M, Davis M, Roshdy MA, Lee A, Seal K, Dean LS, Davis E. Critical Analysis of Vertebral Artery Flow Patterns/Subclavian Steal Detected by Cerebrovascular Duplex Ultrasound Exams and Its Clinical Implications. J Vasc Surg 2022; 76:1634-1641. [PMID: 35835320 DOI: 10.1016/j.jvs.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of subclavian steal (defined as retrograde/bidirectional vertebral artery flow) in the general population and in patients undergoing cerebrovascular duplex ultrasound (CDUS) exams is variable. This is the largest study to date to analyze the incidence of duplex-suggested subclavian steal in 5615 CDUS exams over a one year period and to examine its clinical implications. PATIENT POPULATION AND METHODS All consecutive CDUS exams performed over a one year period were examined for the presence of subclavian steal. Indications of testing, presence of posterior cerebral circulation/subclavian steal symptoms, and any interventions for subclavian steal were analyzed. RESULTS 171/5,615 (3.1%) were found to have subclavian steal (duplex-suggested). 117 (2.1%) had retrograde flow and 54 (1%) had bidirectional flow. 104/171 (60.8%) were left sided. Indications for CDUS were: post CEA/CAS surveillance in 39 patients (22.8%), surveillance for progression of carotid stenosis in 76 patients (44.4%), TIA/stroke in 26 patients (15%), asymptomatic screening/carotid bruit in 18 patients (10.5%) and isolated posterior cerebral circulation symptoms in 12 patients (7%). 63% of patients had associated >50% carotid stenosis. The mean arm Doppler pressure gradient was 32.2 mmHg for asymptomatic patients vs 37mmHg for patients with posterior circulation symptoms (p=.3254). There were significant differences between the mean systolic arm pressure for patients with retrograde vs antegrade vs bidirectional flow (105 mmHg vs 146 vs 134, p<.0001). All patients with retrograde flow had >50% subclavian stenosis or occlusion (100/117 had subtotal/total occlusion) except for one patient. Meanwhile, 52/54 patients with bidirectional flow had >50% subclavian stenosis (6/54 with subtotal/total occlusion) while two patients were normal/<50% stenosis (p<.0001). Overall, 26/171 patients (15.2%) had interventions for disabling symptoms. 11/26 of all interventions were for disabling arm claudication, and only 10/171 patients (5.8%) were done for disabling posterior circulation symptoms with complete resolution of symptoms in all except one. At a late follow-up with a mean of 18 mos. (range 1-37 mos.), there was no late major stroke with only two lacunar infarcts (not subclavian steal related). There were also seven late deaths, none stroke related. CONCLUSIONS The incidence of subclavian steal in patients who undergo CDUS is relatively rare. Most of these patients are asymptomatic and can be treated conservatively with only a few percentage who may need intervention for disabling symptoms with good symptom resolution.
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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304.
| | - Adrian Santini
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304
| | - Matthew Beasley
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304
| | - Meghan Davis
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304
| | | | - Andrew Lee
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304
| | - Kimberly Seal
- Department of Surgery, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304
| | - L Scott Dean
- CAMC Health Education and Research Institute, 3211 MacCorkle Ave., SE, Charleston, WV 25304
| | - Elaine Davis
- CAMC Health Education and Research Institute, 3211 MacCorkle Ave., SE, Charleston, WV 25304
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20
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Li D, Zeng X, Wang J, Yuan D, Zheng T. Effects of different bypass surgeries on LSA revascularization in patients with left subclavian occlusion. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3636. [PMID: 35778375 DOI: 10.1002/cnm.3636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/01/2022] [Accepted: 06/26/2022] [Indexed: 02/05/2023]
Abstract
INTRO Left subclavian artery bypass surgery is mainly carried out for patients with severe left subclavian occlusion. This paper aimed to evaluate the hemodynamic effects of different surgical bypass modes on left subclavian artery revascularization. METHODS Three-dimensional models of the aorta were reconstructed from CTA images of a patient with left subclavian artery occlusion, a patient with type B aortic dissection with left subclavian artery coverage during thoracic endovascular aortic repair, and a healthy 74 year-old man, resulting in six modes for each person: healthy left subclavian artery mode, left subclavian artery occlusion mode and four bypass modes. Hemodynamic parameters, including flow field, flow distribution, pressure gradient, and wall shear stress, were calculated using computational fluid dynamics. RESULTS After left subclavian artery bypass surgery, distal left subclavian artery blood flow resulting from left common carotid artery to distal left subclavian artery bypass was 100% of that in the healthy mode, while the other modes yielded flows at least 91%. Moreover, reversed flow only completely disappeared with left common carotid artery to distal left subclavian artery bypass, whereas reverse flow was observed in the other three modes in early systole. CONCLUSION Left common carotid artery to distal left subclavian artery bypass can effectively reduce reverse blood flow in the left vertebral artery, and it is a feasible, effective, and safe option for left subclavian artery revascularization in patients with left subclavian occlusion.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Xiangguo Zeng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department vascular surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department vascular surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
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21
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Rajendram R, Aldbas AA. Headache may be the only symptom of subclavian steal syndrome after thoracic endovascular aortic repair. BMJ Case Rep 2022; 15:e249166. [PMID: 35623654 PMCID: PMC9150161 DOI: 10.1136/bcr-2022-249166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is currently the treatment of choice for thoracic aortic disease. In select cases, the TEVAR stent must occlude the left subclavian artery. This is usually well tolerated, but the subclavian steal syndrome (SCSS) may occur. Vertebrobasilar insufficiency can cause headaches, but reports of headache as the only symptom of SCSS are very rare. Thus, this may be under-recognised. To increase the awareness of this complication we describe the course of a patient who developed chronic intermittent headaches after intentional occlusion of the left subclavian artery with a TEVAR stent. Revascularisation may be required to prevent adverse neurological outcomes from SCSS. Some authors recommend prophylactic revascularisation whenever the left subclavian artery is sacrificed during TEVAR. However, transposition or bypass of this artery is not without risk and mild symptoms, such as secondary headache, can be fully controlled with conservative measures that reduce steal pathophysiology.
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Affiliation(s)
- Rajkumar Rajendram
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Al Riyadh Province, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Al Riyadh Province, Saudi Arabia
| | - Abdulaziz Abdullah Aldbas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Al Riyadh Province, Saudi Arabia
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22
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Basukala S, Pathak BD, Rijal S, Karki B, Thapa N. Subclavian steal syndrome secondary to atherosclerosis: A case report and review of literature. Clin Case Rep 2022; 10:e05740. [PMID: 35441013 PMCID: PMC9010959 DOI: 10.1002/ccr3.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Subclavian Steal Syndrome (SSS) is a rare vascular syndrome caused due to proximal occlusion or stenosis of subclavian or innominate artery. It is usually asymptomatic but occasionally may present with vertebro‐basilar insufficiency and/or upper limb ischemia. Atherosclerosis is the most common cause.
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Affiliation(s)
- Sunil Basukala
- Department of Surgery Nepalese Army Institute of Health Sciences College of Medicine Kathmandu Nepal
| | - Bishnu Deep Pathak
- Department of Surgery Nepalese Army Institute of Health Sciences College of Medicine Kathmandu Nepal
| | - Sabina Rijal
- Department of Surgery Nepalese Army Institute of Health Sciences College of Medicine Kathmandu Nepal
| | - Bibek Karki
- Department of Radiology Nepalese Army Institute of Health Sciences College of Medicine Kathmandu Nepal
| | - Narayan Thapa
- Department of Surgery Nepalese Army Institute of Health Sciences College of Medicine Kathmandu Nepal
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23
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Nik Mohamed Kamal NMF, Mohamad N, Md Yusoff B. Dizziness and syncope after subclavian steal: A case report of a rarely symptomatic, common vascular disorder. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:82-85. [PMID: 35440963 PMCID: PMC9004442 DOI: 10.51866/cr1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Subclavian steal syndrome (SSS) is a manifestation of vertebrobasilar artery insufficiency due to stenosis of the proximal subclavian artery. It is a common vascular disorder; however, most patients are asymptomatic, and the disorder is commonly found incidentally during imaging. Nevertheless, some patients may present with arm ischemia or signs and symptoms of vertebrobasilar insufficiency, such as vertigo, dizziness, diplopia, ataxia, dysarthria, and syncopal episodes. We present a case of a male patient who presented with sudden onset dizziness, syncopal episodes, and blood pressure discrepancy between his arms. Diagnosis was a challenge, and the patient underwent several investigations, including basic bloodwork, electrocardiography (ECG), echocardiography, brain computed tomography (CT), and coronary CT angiography (CTA). Narrowing in the proximal left subclavian artery was found during coronary CTA, which confirmed the diagnosis of SSS.
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Affiliation(s)
- Nik Mohamed Firdaus Nik Mohamed Kamal
- MBBCh (Mansoura), Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nasibah Mohamad
- MD (USM), MMed(Radiology), Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
- School of Medical Sciences Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Bazli Md Yusoff
- MB BCh BAO (Ireland), MMed (Radiology), Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian Kelantan, Malaysia,
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24
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Ahmed MA, Parwani D, Mahawar A, Gorantla VR. Subclavian Artery Calcification: A Narrative Review. Cureus 2022; 14:e23312. [PMID: 35464515 PMCID: PMC9015066 DOI: 10.7759/cureus.23312] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/02/2023] Open
Abstract
Subclavian artery calcification (SAC) affects 2% of the population and presents a serious risk of developing into subclavian steal syndrome (SSS). Risk factors for plaque formation of the subclavian artery include diabetes, hypertension, and smoking. While SAC generally presents as asymptomatic, symptoms in severe cases may include numbness, pain at rest, and ischemic gangrene. Patients with severe SSS are at high risk of developing neurological symptoms as a result of vertebrobasilar insufficiency affecting posterior cerebral perfusion. On physical examination, SSS is preliminarily diagnosed from bilateral inter-arm systolic blood pressure discrepancy (>10 mmHg), which can be further confirmed with vascular imaging. Duplex ultrasound (DUS) is a cost-effective and non-invasive baseline technique for visualizing luminal stenosis and quantifying peak systolic velocity (PSV). Computed tomography angiography (CTA) provides high-quality, fast, three-dimensional (3D) imaging at the cost of introducing nephrotoxic contrast agents. Magnetic resonance angiography (MRA) is the safest 3D imaging modality, without the use of X-rays and contrast agents, that is useful in assessing plaque characteristics and degree of stenosis. DUS-assisted digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis in the subclavian artery and determining the distance between the puncture site and lesion, which can be carried out in a combined procedure with endovascular management strategies. The fundamental treatment options are surgical and endovascular intervention. Endovascular treatment options include percutaneous transluminal angiography (PTA) for recanalization of the stenosed vessel and permanent balloon stenting to prevent collapse after PTA. Overall, the benefits of endovascular management encompass faster recovery, lower stenosis recurrence rate, and lower incidence of complications, making it the treatment of choice in low-risk patients. Surgical interventions, although more complex, are considered gold-standard treatment options.
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Cornelissen SA, Heye S, Maleux G, Daenens K, van Loon J, De Vleeschouwer S. Treatment of ruptured subclavian steal flow-related vertebrobasilar junction aneurysms: Case report on surgical and endovascular considerations from two cases. Int J Surg Case Rep 2022; 90:106744. [PMID: 34991048 PMCID: PMC8741505 DOI: 10.1016/j.ijscr.2021.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Subclavian steal phenomenon causes retrograde flow through the vertebral artery, ipsilateral to the affected subclavian artery, which rarely leads to flow-related vertebrobasilar junction (VBJ) aneurysms. Case descriptions We describe two cases of subarachnoid hemorrhage from such ruptured aneurysms in which the retrograde flow direction in the vertebral artery complicated surgical and endovascular treatment. Discussion Reversed flow in the vertebral artery, ipsilateral to the stenotic subclavian artery leads to a lack of proximal control in surgical clipping of these VBJ aneurysms and jeopardizes stability of coil and stent placement in endovascular aneurysm treatments in this setting. Conclusion: From these 2 experiences over 7 years, treatment considerations emerged for future cases. Subclavian steal phenomenon can be associated with flow-related cerebral aneurysms. These aneurysms are located at the vertebrobasilar junction. If ruptured, treatment of these aneurysms is challenging. Reversed vertebral artery flow complicates any type of aneurysm repair. Recanalization of stenotic subclavian artery contributes sustainable solutions.
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Abstract
The definition of subclavian steal is subclavian artery occlusion or hemodynamically significant stenosis proximal to the origin of the vertebral artery that results in lower pressure in the distal subclavian artery. Although subclavian steal can often remain asymptomatic, if ignored, it can cause syncope or neurological deficits. Detailed routine evaluation of blood pressure and careful physical examination, simultaneously on both sides of patients at high vascular risk (such as those with hypertension, dyslipidemia, and diabetes), can assist in the early detection. Herein, we report the case of an 82-year-old male patient with steal syndrome, who had no subjective symptoms despite severe stenosis of the subclavian artery, with a marked left-right difference in blood pressure.
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Affiliation(s)
- Yu Amano
- Faculty of Medicine, Shimane University, Izumo, JPN
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, JPN
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Prevalence and Clinical Characteristics of Subclavian Steal Phenomenon/Syndrome in Patients with Acute Ischemic Stroke. J Clin Med 2021; 10:jcm10225237. [PMID: 34830519 PMCID: PMC8621575 DOI: 10.3390/jcm10225237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/21/2022] Open
Abstract
There are no published clinical studies regarding the prevalence of subclavian steal among acute ischemic stroke patients. The aim of this study was to evaluate the prevalence and clinical significance of subclavian steal among a large number of consecutive ischemic stroke patients. Materials and methods: We reviewed the medical records of 2192 consecutive cases of acute ischemic stroke at a tertiary neurology clinic in Targu Mures, Romania, between 2018 and 2020. In total, 47 patients (2.2%) were diagnosed with subclavian steal phenomenon/syndrome. Results: Stroke patients with associated steal phenomenon were significantly younger (64.2 ± 11.1 versus 70.2 ± 12.8, p = 0.005) and predominantly male (68.1%). From among the 47 patients with subclavian steal phenomenon, nine (19.1%) presented stroke symptomatology in the vertebrobasilar territory. Overall, 83.3% of the stroke patients with associated steal phenomenon presented cerebral infarction and 16.7% presented TIA. There was no difference between groups regarding the affected vascular territory (VB versus carotid). Large artery atherosclerosis was more frequent in the stroke group with associated steal phenomenon (81.3% versus 43.5%, p = 0.0033). The NIHSS score at admission was higher in the patient group with associated steal phenomenon, but there was no difference in mRS at discharge. Associated carotid artery occlusion was more frequent in the stroke group with steal phenomenon (p < 0.01). Smoking and peripheral arteriopathy were more frequent in the patient group with associated steal phenomenon. Of the nine symptomatic patients, five underwent revascularization treatment. Conclusions: The prevalence of subclavian steal phenomenon among acute ischemic stroke patients was not higher than in other cohorts with heterogenous peripheral vascular pathologies. Similar to the general population, in acute ischemic stroke patients, the associated subclavian steal behaved like a benign hemodynamical condition, without severe consequences.
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Gupta S, Klebanoff MJ, Pathak A, Unaka NI, Herbst B. Falling Through the Cracks. J Hosp Med 2021; 16:694-698. [PMID: 34328836 DOI: 10.12788/jhm.3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Shaili Gupta
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine, VA Healthcare Systems of Connecticut, West Haven, Connecticut
| | - Matthew J Klebanoff
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ashutosh Pathak
- Department of Radiology and Biomedical Imaging, VA Healthcare Systems of Connecticut, West Haven, Connecticut
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Herbst
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Shimbo G, Echigo R, Takiguchi M. The use of 4-dimensional magnetic resonance angiography as a noninvasive procedure to diagnose subclavian steal syndrome in a dog. J Am Vet Med Assoc 2021; 259:1040-1042. [PMID: 34647481 DOI: 10.2460/javma.259.9.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 5-year-old 4.1-kg (9.0-lb) spayed female Toy Poodle was referred because of a 6-month history of sporadic signs of neck pain. CLINICAL FINDINGS Diagnostic imaging with MRI and CT revealed a dilated radicular artery connecting the right and left vertebral arteries and causing mild compression of the spinal cord. The left subclavian artery caudal to the origin of the left vertebral artery was absent. Subclavian steal syndrome (SSS) was suspected. TREATMENT AND OUTCOME The owner declined surgical treatment; thus, the dog was treated conservatively with glucocorticoids and analgesics. Eight months later, the dog's clinical signs were unchanged but palliated with the administration of glucocorticoids and analgesics, and 4-dimensional (4-D) magnetic resonance angiography (MRA) revealed that the left vertebral artery received blood supply from the right vertebral artery through the dilated radicular artery and that the left vertebral artery caudal to this site had retrograde flow and drained into the left subclavian artery, confirming the diagnosis of SSS. The owner again declined surgery, and conservative treatment continued. The dog's condition was unchanged at the last follow-up communication 11 months after 4-D MRA. CLINICAL RELEVANCE Subclavian steal syndrome is an extremely rare condition in dogs, and our findings suggested that 4-D MRA could be used to definitively diagnose SSS in dogs.
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Hao LJ, Zhang J, Naveed M, Chen KY, Xiao PX. Subclavian steal syndrome associated with Sjogren's syndrome: A case report. World J Clin Cases 2021; 9:8171-8176. [PMID: 34621877 PMCID: PMC8462188 DOI: 10.12998/wjcc.v9.i27.8171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/16/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subclavian steal syndrome (SSS) caused by Sjogren's syndrome is rare, especially for elderly patients with risk factors for atherosclerosis. The current report presents the uncommon etiology and treatment of SSS, aiming to improve doctor’s clinical experience.
CASE SUMMARY A 69-year-old man was diagnosed with hypertension and acute cerebral infarction presenting with left upper limb weakness and pain even gradually aggravating to left limb hemiplegia 30 years ago. He was managed with antihypertensive and antithrombotic therapy; however, his condition was recurrent, and he never had any further examination. It was found that the difference of the bilateral upper arm systolic pressure was over 20 mmHg, and Doppler examination showed that the blood flow of the left vertebral artery was reversed, suggesting SSS. Further tests revealed a benign lymphoepithelial lesion in salivary gland tissue, confirming the Sjogren's syndrome.
CONCLUSION The patient was found to have hypertension when he was 33 years old, and the blood pressure of both sides was asymmetric, which was ignored. The patient's symptoms of dizziness and upper limb weakness were misdiagnosed as general cerebral infarction. It is necessary to test the aorta computed tomography angiography to prove secondary hypertension factors such as Sjogren's syndrome.
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Affiliation(s)
- Li-Jun Hao
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Jing Zhang
- Department of Clinical Pharmacology, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Muhammad Naveed
- Department of Clinical Pharmacology, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Kai-Yan Chen
- Department of Clinical Medicine, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Ping-Xi Xiao
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
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Song D, Ireifej B, Seen T, Almas T, Sattar Y, Chadi Alraies M. Diagnosis and management of unilateral subclavian steal syndrome with bilateral carotid artery stenosis. Ann Med Surg (Lond) 2021; 68:102597. [PMID: 34377448 PMCID: PMC8329505 DOI: 10.1016/j.amsu.2021.102597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 01/22/2023] Open
Abstract
Subclavian steal syndrome is a rare phenomenon occurring from retrograde blood flow in the vertebral artery due to proximal stenosis in the subclavian artery. As a result, the arm gets blood supply from the vertebral artery at the expense of the vertebrobasilar system. The patient remains largely asymptomatic until there is an increase demand for blood supply to the arm, resulting in a constellation of symptoms including dizziness, vertigo, blurred vision, diplopia, headache, syncope, postural hypotension, neurologic deficits, and rarely, memory problems. The management approach depends on the severity of clinical symptoms but includes medical treatment, endovascular therapy and lifestyle modifications. Subclavian steal syndrome with concurrent carotid artery stenosis is only the second documented case, which makes it an extremely rare presentation or frequently unnoticed condition. Absence of symptoms does not rule out subclavian steal syndrome with bilateral carotid stenosis and should be considered in the differential in patients with high risk comorbidities with appropriate imaging and physical exam. The treatment depends on the severity of clinical symptoms but includes medical treatment, endovascular therapy and lifestyle modifications.
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Affiliation(s)
- David Song
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Branden Ireifej
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Tasur Seen
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - M Chadi Alraies
- Division of Interventional Cardiology, Detroit Medical Center, Detroit, MI, USA
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El Bhali H, Bounssir A, Bakkali T, Jdar A, El Khloufi S, Lekehal B. Symptomatic subclavian steal syndrome: Report of four Moroccan cases and literature review. Int J Surg Case Rep 2021; 85:106173. [PMID: 34284339 PMCID: PMC8318908 DOI: 10.1016/j.ijscr.2021.106173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Subclavian steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery. Materials and methods Four patients with subclavian steal syndrome were treated in our center. Percutaneous radial approach was used for angioplasty, primary stenting of subclavian artery was performed, surgical techniques in particular carotid-subclavian bypass and carotid-subclavian transposition were used. Results We report the cases of four patients, three of which are male, with an average age of 60 years. All of them were symptomatic. Diagnosis was made by duplex ultrasound, supplemented by CT-angiography and arteriography. Endovascular treatment was attempted in all four patients, which was successful in two patients, who underwent primary stenting, and failed for the two others, for whom surgical treatment was considered. One had a subclavio-carotid bypass graft with a polytetrafluorethylene (PTFE) prosthesis and the other had a subclavio-carotid transposition. The technical results were satisfactory in all patients with symptoms resolution. The postoperative evolution was without notable complications and the postoperative checkups were satisfactory. Discussion There are excellent screening tools and effective medical therapies which can be instituted if the SSS is diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness. Nevertheless, large, prospective, randomized and controlled trials are needed to compare the long-term patency rates between the endovascular and surgical techniques. SSS is caused by the reversal of blood flow in the vertebral artery. Doppler ultrasound is the ultimate screening tool for diagnosis. Treatment of symptomatic SSS is always indicated. Endovascular approach is the first-line treatment.
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Affiliation(s)
- Hajar El Bhali
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco.
| | - Ayoub Bounssir
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Tarik Bakkali
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Asmae Jdar
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Samir El Khloufi
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
| | - Brahim Lekehal
- Mohammed V University of Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital, 10104, Souissi, Rabat, Morocco
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Local Hemodynamic Changes Immediately after Correction of an Aberrant Right Subclavian Artery in a Dog: A Contrast Computed Tomographic Study. Vet Sci 2021; 8:vetsci8060104. [PMID: 34201119 PMCID: PMC8230020 DOI: 10.3390/vetsci8060104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
A 1-year-old female Akita dog was referred for intermittent regurgitation. Computed tomographic angiography (CTA) showed an aberrant right subclavian artery (ARSA), resulting in constriction of the esophagus. After surgical ligation of the ARSA, CTA showed that the ARSA was not enhanced by contrast medium, and that sufficient collateral circulation of the right forelimb was supplied through the vertebral artery. Furthermore, the right and left vertebral arteries merged into the basilar artery at the level of the atlas, and no abnormal expansion of the ventral spinal artery was observed. Overall, we demonstrated the importance of post-surgical CTA for identification of surgical complications, including the formation of abnormal vessel alterations.
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Huang CC, Huang WM, Jhou ZY, Chen JH, Chen ST, Lin HC, Huang CY, Chen CH, Luo CB, Chang FC. Angioplasty and stenting for symptomatic stenosis of the left subclavian artery complicated with aortic dissection. J Chin Med Assoc 2021; 84:273-279. [PMID: 33496512 DOI: 10.1097/jcma.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection. METHODS Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients. RESULTS Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%-95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7-118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency. CONCLUSION Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection.
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Affiliation(s)
- Chun-Chao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Wei-Ming Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Zong-Yi Jhou
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Jung-Hsuan Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hui-Chen Lin
- Department of Radiology, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan, ROC
| | - Chung-Yao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chia-Hung Chen
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Cho U, Kim SK, Ko JM, Yoo J. Unusual presentation of granulomatosis with polyangiitis causing periaortitis and consequent subclavian steal syndrome: A case report. World J Clin Cases 2021; 9:1433-1438. [PMID: 33644212 PMCID: PMC7896677 DOI: 10.12998/wjcc.v9.i6.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease that involves small-to-medium-sized vessels and forms necrotizing vasculitis with granulomatous inflammation. The formation of a large vessel lesion in GPA patients has been scarcely reported, and it can cause confusion in the diagnosis.
CASE SUMMARY A 27-year-old man presented with mild left-sided pleuritic chest pain that started one year prior. An imaging study revealed up to 2.5 cm-sized two irregular nodular consolidation nodule in the left lower lobe. Both nodules showed central necrosis. Also, there was a periaortic mass occluding the branching porting of the subclavian artery. He had positive anti-neutrophil cytoplasmic antibodies (ANCAs), but myeloperoxidase-ANCAs and proteinase 3-ANCAs were negative. The patient also developed symptoms of subclavian vein syndrome during the follow-up. Wedge resection of the lung revealed necrotizing vasculitis, destructive parenchymal abscess and surrounding granuloma, and therefore diagnosed of GPA. The patient started on methotrexate and steroid therapy with a relief of symptomatic.
CONCLUSION Here, we present an unusual manifestation of GPA with periaortitis and consequent subclavian steal syndrome, which has never been previously described. This case alerts us that we should include GPA in the differential diagnosis of large vessel vasculitis as well as subclavian steal syndrome.
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Affiliation(s)
- Uiju Cho
- Department of Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Sung-Kyung Kim
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jeong Min Ko
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jinyoung Yoo
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
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Isolated left subclavian artery with right aortic arch: case report and literature review of 50 cases. Gen Thorac Cardiovasc Surg 2021; 69:885-889. [PMID: 33475911 DOI: 10.1007/s11748-020-01564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
Isolated left subclavian artery (ILSA) with right aortic arch is a rare vascular anomaly accounting for 0.8% in all right-sided aortic arch anomalies. We report a case of an isolated left subclavian artery with right aortic arch and a combination of subclavian as well as pulmonary steal in infant with Tetralogy of Fallot. We reviewed and summarized 50 similar cases reported in the literature over the last 30 years, in order to gain a thorough understanding of this rare anomaly.
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Smith MC, Pham R, Coffey N, Kazimuddin M, Singh A. Coronary Subclavian Steal Syndrome With Neurological Symptoms After Coronary Artery Bypass Grafting. Cureus 2021; 13:e12833. [PMID: 33633876 PMCID: PMC7899255 DOI: 10.7759/cureus.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronary subclavian steal syndrome (CSSS) is a complication of coronary artery bypass graft surgery with the left internal mammary artery that results from left subclavian artery stenosis. A reversal of flow in the left internal mammary artery results in ischemia of the heart. We present the case of a 54-year-old man with CSSS with the rare symptom of dizziness. This indicates a potential component of undiagnosed vertebral steal syndrome as well.
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Affiliation(s)
- Megan C Smith
- Cardiology, The Medical Center/University of Kentucky, Bowling Green, USA
| | - Rich Pham
- Cardiology, The Medical Center/University of Kentucky, Bowling Green, USA
| | - Nicholas Coffey
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
| | | | - Aniruddha Singh
- Cardiology, The Medical Center/University of Kentucky, Bowling Green, USA
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Kovarova L, Valerianova A, Michna M, Malik J. Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation. J Vasc Access 2020; 22:90-93. [PMID: 32489138 DOI: 10.1177/1129729820924561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Decreased cerebral perfusion and oxygenation are common in hemodialysis patients. Magnitude of the arteriovenous fistula involvement in this phenomenon is not known. The aim of this study was to investigate the effect that a short-term arteriovenous fistula flow interruption has on cerebral oxygenation and to review and suggest possible explanations. METHODS In 19 patients, basic laboratory and clinical data were obtained and arteriovenous fistula flow volume was measured by ultrasonography. Baseline regional cerebral oxygen saturation (rSO2) was measured by near-infrared spectroscopy. Manual pressure was then applied on the fistula, resulting in total blood flow interruption. After 1 min of manual compression, rSO2 and blood pressure values were noted again. The compression-related change in rSO2 was assessed, as well as its association with arteriovenous fistula flow volume, blood pressure, and other parameters. RESULTS Mean cerebral rSO2 increased after arteriovenous fistula compression (from 53.6% ± 11.4% to 55.6% ± 10.8%; p = 0.000001; 95% confidence interval = 1.39-2.56). The rSO2 increase was higher in patients with lower rSO2 at baseline (r = -0.46; p = 0.045). CONCLUSION A significant rise in cerebral oxygenation was observed following the manual compression of arteriovenous fistula. Therefore, the arteriovenous fistula could have a role in impaired cerebral oxygenation in hemodialysis patients.
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Affiliation(s)
- Lucie Kovarova
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Anna Valerianova
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Michna
- Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Malik
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Ibrahimagić OĆ, Smajlović D, Dostović Z, Kunić S, Iljazović A. Subclavian steal syndrome: the stealer of skin temperature? Acta Neurol Belg 2020; 120:717-718. [PMID: 31473942 DOI: 10.1007/s13760-019-01201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Omer Ć Ibrahimagić
- Department of Neurology, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Dževdet Smajlović
- Department of Neurology, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Zikrija Dostović
- Department of Neurology, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Suljo Kunić
- Department of Neurology, Primary Health Care Center, V. L. Kurjaka 66, 75000, Tuzla, Bosnia and Herzegovina.
| | - Amra Iljazović
- Department of Neurology, University Clinical Center, Tuzla, Bosnia and Herzegovina
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Agrawal V, Majid A, Jain I, Sheth M, Mishra A. Type II Aortopulmonary Window with Isolated Left Subclavian Artery from Left Pulmonary Artery. Braz J Cardiovasc Surg 2020; 35:402-405. [PMID: 32549112 PMCID: PMC7299581 DOI: 10.21470/1678-9741-2018-0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Type II Aortopulmonary window (APW) accounts for only 10% of total cases of APW, which by itself is a rare congenital anomaly. Various cardiac malformations have been reported to be associated with this rare anomaly. We report one such association of origin of left subclavian artery (LSCA) from left pulmonary artery (LPA) via ductus arteriosus that was surgically repaired.
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Affiliation(s)
- Vishal Agrawal
- Mehta Institute of Cardiology & Research Centre Department of Cardiovascular and Thoracic Surgery Gujarat India Department of Cardiovascular and Thoracic Surgery, UNMICRC - U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, India
| | - Abdul Majid
- Mehta Institute of Cardiology & Research Centre Department of Cardiovascular and Thoracic Surgery Gujarat India Department of Cardiovascular and Thoracic Surgery, UNMICRC - U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, India
| | - Imelda Jain
- Mehta Institute of Cardiology & Research Centre Department of Cardiac Anaesthesia Gujarat India Department of Cardiac Anaesthesia, UNMICRC - U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, India
| | - Megha Sheth
- Mehta Institute of Cardiology & Research Centre Department of Radiology Gujarat India Department of Radiology, UNMICRC - U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, India
| | - Amit Mishra
- Mehta Institute of Cardiology & Research Centre Department of Pediatric Cardiovascular and Thoracic Surgery Gujarat India Department of Pediatric Cardiovascular and Thoracic Surgery UNMICRC - U. N. Mehta Institute of Cardiology & Research Centre, Gujarat, India
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Chen DW, Gao YH, Shi J, Yin YW, Zhang WQ. Significance of hemodynamic assessment by pressure wire for endovascular therapy of subclavian steal syndrome. Interv Neuroradiol 2020; 26:321-328. [PMID: 31969074 DOI: 10.1177/1591019919897765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Subclavian steal syndrome results from hemodynamic impairment due to stenosis or occlusion of subclavian artery. Therefore, it is important for subclavian steal syndrome patients to assess hemodynamic status during endovascular therapy. METHODS Eleven subclavian steal syndrome patients undergoing endovascular therapy attended this study. Pressure wire was used to measure trans-stenosis pressure difference (ΔP). Digital subtraction angiography, Transcranial Doppler and Electronic sphygmomanometer were introduced to assess stenotic rate, steal grade and inter-arm systolic pressure difference, respectively. Clinical symptoms and restenosis were followed up after endovascular therapy. The associations of ΔP with stenotic rate, inter-arm pressure difference, steal degree, clinic symptoms and restenosis were analyzed in this paper. RESULTS Prior to the therapy, ΔP moderately correlated with stenotic rate (r = 0.757, p = 0.007) and inter-arm pressure difference (r = 0.701, p = 0.016). ΔP was ≥6 mmHg in all patients, and 6-9 mmHg for grade 1 steal and ≥10 mmHg for grade 2 and 3 steals. After the therapy, all patients had technique success, and 10 patients had clinic success, and 1 patient appeared restenosis. ΔP was ≤3 mmHg and steal disappeared in the patients with clinical success. ΔP was 18 mmHg and grade 3 steal still existed in one patient without clinical success. One patient with 1 mmHg of ΔP after therapy appeared restenosis in the follow-up. CONCLUSION The trans-stenosis pressure difference is closely related to steal degree and clinical symptoms. The measurement of hemodynamic status by pressure wire is very useful to guide endovascular therapy in subclavian steal syndrome patients. However, the restenosis may still occur, even though the hemodynamic impairment is improved.
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Affiliation(s)
- Da-Wei Chen
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yu-Hai Gao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Shi
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Yan-Wei Yin
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
| | - Wei-Qing Zhang
- Department of Neurology, Air Force Medical Center, PLA (People's Liberation Army), Beijing, China
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Subclavian steal syndrome: A forgotten aetiology of acute cerebral ischaemia. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Considerations for accurate blood pressure measurement in clinical care and research. JOURNAL OF VASCULAR NURSING 2019; 37:274-276. [PMID: 31847983 DOI: 10.1016/j.jvn.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Transcranial Doppler ultrasonography (TCD) is a noninvasive, bedside, portable tool for assessment of cerebral hemodynamics. Modern TCD head frames allow continuous hands-free emboli detection for risk stratification and assessment of treatment efficacy in several cardiovascular diseases. Identifying a focal stenosis, arterial occlusion, and monitoring the treatment effect of intravenous tissue plasminogen activator can easily be accomplished by assessing TCD waveforms and determining prestenotic and poststenotic mean flow velocities. TCD is an excellent screening tool for vasospasm in aneurysmal subarachnoid hemorrhage. The use of intraoperative TCD during carotid endarterectomy and stenting allows optimal intraoperative hemodynamic management. Other applications are also discussed.
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Affiliation(s)
- Ryan Hakimi
- Director, Neuro ICU, Inpatient Neurology, and TCD Services, Greenville Memorial Hospital, Prisma Health-Upstate, University of South Carolina School of Medicine-Greenville, 200 Patewood Drive, Suite B350, Greenville, SC 29615, USA.
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163, USA
| | - Zsolt Garami
- Institute for Academic Medicine, Research Institute, Houston, TX, USA; Vascular Ultrasound Laboratory, Houston Methodist Hospital, Weill Cornell Medical College, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA
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Coceani M, Sbrana F, Ciardetti M, Pino BD, Palmieri C, Berti S, Giannoni A, Emdin M, Sampietro T. High-risk NSTEMI due to Subclavian Artery Atherothrombosis in a Prior Coronary Artery Bypass Graft Patient. J Cardiovasc Echogr 2019; 29:86-87. [PMID: 31392128 PMCID: PMC6657466 DOI: 10.4103/jcecho.jcecho_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michele Coceani
- Division of Interventional Cardiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis and Inherited Dyslipidemias Center, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Ciardetti
- Division of Interventional Cardiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Pisa, Italy
| | - Beatrice Dal Pino
- Lipoapheresis and Inherited Dyslipidemias Center, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Cataldo Palmieri
- Division of Interventional Cardiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Pisa, Italy
| | - Sergio Berti
- Division of Interventional Cardiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Pisa, Italy
| | - Alberto Giannoni
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Tiziana Sampietro
- Lipoapheresis and Inherited Dyslipidemias Center, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Nishie R, Toya N, Fukushima S, Ito E, Murakami Y, Misawa T, Ohki T. Two cases of asymptomatic axillary artery occlusion difficult to diagnose preoperatively: pitfalls and its solution in endovascular therapy when approaching from the upper extremity. Surg Case Rep 2019; 5:121. [PMID: 31352548 PMCID: PMC6661044 DOI: 10.1186/s40792-019-0670-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Approaching from the left brachial artery is an important access route in endovascular therapy for complicated aortic and peripheral artery cases. Here, we report two cases of a poor access route from the left brachial artery because of asymptomatic axillary artery occlusion (AAO), despite no preoperative upper arm blood pressure laterality, a normal ankle brachial pressure index, and absence of occlusion of the subclavian artery on CT scan. CASE 1: Seventy-six-year-old female. We planned endovascular aneurysm repair (EVAR) for para-renal abdominal aortic aneurysm using the snorkel technique in the renal artery, but we failed to pass through the left subclavian artery when approaching from the left brachial artery because of AAO. CASE 2: Seventy-three-year-old female. We planned zone 2 thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm and embolization of the left subclavian artery via the left brachial artery, but we failed to pass through the left subclavian artery because of AAO, and therefore, we simply covered the orifice of the left subclavian artery using a stent graft without embolization. CONCLUSIONS The presence of an asymptomatic AAO may alter the treatment plan but may be difficult to diagnose preoperatively. In those cases in which a brachial or radial artery access is planned, contrast medium should be injected from the contralateral upper extremity during preoperative enhanced CT since the absence of halation of the ipsilateral subclavian/axillary vein provides improved visualization of the AAO which may lead to a better preoperative strategy including the choice of the side of upper extremity access.
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Affiliation(s)
- Ryosuke Nishie
- Department of Vascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Naoki Toya
- Department of Vascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Soichiro Fukushima
- Department of Vascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Eisaku Ito
- Department of Vascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yuri Murakami
- Department of Vascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takeyuki Misawa
- Department of Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takao Ohki
- Department of Vascular Surgery, Jikei University School of Medicine, 3-19-18, Nishi-shinbashi, Minato-Ku, Tokyo, 105-0003, Japan.
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Dehghan A, Haseli S, Keshavarz P, Ahmadi M, Dehghani P. Be Aware of Aberrant Right Subclavian Artery Origin Before Aortic Coarctation Stenting: A Case Report Study. Vasc Endovascular Surg 2019; 53:609-612. [PMID: 31309863 DOI: 10.1177/1538574419858827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.
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Affiliation(s)
- Alireza Dehghan
- 1 Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Haseli
- 1 Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- 1 Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Ahmadi
- 1 Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Dehghani
- 2 Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Kuć J, Szarejko KD, Aleksandrowicz K, Gołębiewska M. The role of soft tissue mobilization in reducing orofacial and general complaints in a patient with Kimmerle anomaly and temporomandibular joint disorder: A case report. Cranio 2019; 39:74-87. [DOI: 10.1080/08869634.2018.1560616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna Kuć
- Department of Prosthodontics, Medical University of Bialystok, Bialystok, Poland
| | | | - Krzysztof Aleksandrowicz
- Department of Health Care Sciences, History of Physical Medicine and Balneology, Medical University of Wroclaw, Wroclaw, Poland
| | - Maria Gołębiewska
- Department of Prosthodontics, Medical University of Bialystok, Bialystok, Poland
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梁 毅, 丘 丽, 谢 静. [Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1509-1513. [PMID: 30613022 PMCID: PMC6744209 DOI: 10.12122/j.issn.1673-4254.2018.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, P=0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; t= 629.5, P=0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) vs 7.7%(3/39);χ2=8.603, P=0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
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Affiliation(s)
- 毅仪 梁
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 丽雅 丘
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 静芳 谢
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
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Rafailidis V, Li X, Chryssogonidis I, Rengier F, Rajiah P, Wieker CM, Kalva S, Ganguli S, Partovi S. Multimodality Imaging and Endovascular Treatment Options of Subclavian Steal Syndrome. Can Assoc Radiol J 2018; 69:493-507. [DOI: 10.1016/j.carj.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vasileios Rafailidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xin Li
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ioannis Chryssogonidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fabian Rengier
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Prabhakar Rajiah
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carola M. Wieker
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sanjeeva Kalva
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suvranu Ganguli
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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