Diagram of subclavian artery steal syndrome
Today, Mr. Li is going to be discharged from the hospital. The blogger sent flowers to Mr. Li and his past students also came to congratulate him, and he is very happy that today, just two days after the operation, he can be discharged from the hospital. Five years ago, Mr. Li found low blood pressure in his left arm, often dizziness, left arm can not feel the pulse, has been busy with work, and some fear of surgery, has not done treatment. Now, Mr. Li’s left arm feels a strong pulse, and his head is not dizzy. What disease does Mr. Li suffer from? The medical term is subclavian artery theft syndrome, what is it?
Subclavian steal syndrome
Subclavian steal syndrome
[Synonym] Brachio-basilar artery insufficiency, subclavian artery reflux syndrome.
[The syndrome was first described by Contoni in 1960.
It was first described by Contoni in 1960 and further named as subclavian artery steal syndrome by Reiveich in 1961. Subclavian artery steal syndrome is a group of syndromes in which partial or complete occlusion of the unnamed artery or the proximal end of the subclavian artery before it divides from the vertebral artery causes a reverse flow of blood from the affected vertebral artery to the ischemic upper extremity due to siphoning, resulting in an ischemic attack of the vertebrobasilar artery and ischemic symptoms in the affected upper extremity.
[The vast majority of subclavian artery lesions are the result of atherosclerosis. Since the left subclavian artery emanates directly from the aortic arch, the lesions are mostly located on the left side. This is followed by various arteritis, congenital arteriovenous malformations (aortic arch stenosis, subclavian artery dysplasia), trauma, and vascular surgery involving the subclavian artery. After occlusion of the subclavian artery, there is a reverse pressure difference between the basilar artery and the subclavian artery. When the pressure difference is equal to 10% of the systolic pressure of the body circulation, the blood from the vertebral artery stops and flows backward to the subclavian artery, so that the blood supply to not only the upper limbs but also the brain decreases to varying degrees. With the development of the disease, the body compensates for the blood flow from the vertebral artery or carotid artery to the basilar artery by Willis ring, but when the shoulder and upper limb activities increase the need for additional blood supply, more blood will be “stolen” from the vertebral-basilar artery, which indirectly causes the lack of cerebral blood supply, resulting in a series of clinical manifestations of upper limb and cerebral ischemia.
[Clinical manifestations] The main manifestation is ischemia of the brain and the affected upper extremity. Often, the ischemic symptoms of the brain attack when the affected upper limb is exerted. The main symptoms are: 1 Cochlear vestibular nerve symptoms: vertigo, often appearing suddenly, associated with head rotation or tilt, accompanied by ataxia. There is also nausea, tinnitus, and hearing impairment. (ii) Vascular headache, which may be accompanied by syncope. (③Ocular symptoms: such as diplopia, paroxysmal blindness, transient bilateral visual field defects (ipsilateral hemianopia). ④Numbness or abnormal sensation in one or more limbs and weakness and fatigue in the affected upper limbs. ⑤ Difficulty in swallowing, dysphonia, memory loss, etc.
Signs: mainly the radial artery and brachial artery pulsation of the affected upper limb is weakened or disappeared. The blood pressure of the affected upper extremity decreases, usually by 20-50 mmHg (2.67-6.67 kPa) in most cases. Prolonged inadequate blood supply is seen in muscle atrophy of the affected extremity, low skin temperature of the fingers and palms, and vascular murmur or tremor is heard in the walking part of the subclavian artery.
[Diagnosis and differential diagnosis]
1, with symptoms of episodic vertebrobasilar artery insufficiency, especially with concomitant ischemic symptoms of the upper extremity.
2.Weak or absent ipsilateral radial and brachial artery pulsations, and systolic blood pressure (affected limb) decreases by more than 20 mmHg (2.67 kPa) or disappears.
3.Ischemic symptoms are aggravated after lifting up the affected limb.
4. CT angiography (CTA), MRI (MRA) and aortic arch angiography of the neck can help clarify the diagnosis. This syndrome should be differentiated from chest out syndrome, coronary heart disease, cerebral infarction, transient ischemic attack, and obese cerebrovascular syndrome.
[Treatment]
1.Treat the risk factors leading to atherosclerosis, such as hypertension, diabetes mellitus and hyperlipidemia, accordingly.
2.Anticoagulation therapy to prevent embolism or (and) reduce the development of thrombosis in the affected limb.
3.Interventional endoluminal therapy: After the occlusion of subclavian artery stenosis is lifted by balloon dilation and stent implantation, the reflux of the affected vertebral artery disappears, thus eliminating subclavian artery blood theft, with little injury, fast recovery and good effect. It is the preferred method of treatment at present.
4.Surgical treatment: Intraluminal intervention is unsuccessful, or stent occlusion can be considered for surgery, such as thromboendarterectomy, artificial vascular bypass surgery, transposition surgery, etc.
[Prognosis] Surgery and endoluminal treatment can achieve good results, and most of the cases recover the normal radial artery and blood pressure on the affected side soon after surgery, and the symptoms of cerebral and upper limb ischemia also improve rapidly.
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[Diagnosis and Differential Diagnosis]
1, with symptoms of episodic vertebrobasilar artery insufficiency of blood supply, especially accompanied by ischemic symptoms of the upper limbs at the same time.
2, Weakness or disappearance of ipsilateral radial and brachial artery pulsations, and decrease or disappearance of systolic blood pressure (affected limb) by more than 20 mmHg (2.67 kPa).
3.Ischemic symptoms are aggravated after lifting up the affected limb.
4. CT angiography (CTA), MRI (MRA) and aortic arch angiography of the neck can help clarify the diagnosis. This syndrome should be differentiated from chest out syndrome, coronary heart disease, cerebral infarction, transient ischemic attack, and obese cerebrovascular syndrome.
[Treatment]
1.Treat the risk factors leading to atherosclerosis, such as hypertension, diabetes mellitus and hyperlipidemia, accordingly.
2.Anticoagulation therapy to prevent embolism or (and) reduce the development of thrombosis in the affected limb.
3.Interventional endoluminal therapy: After the occlusion of subclavian artery stenosis is lifted by balloon dilation and stent implantation, the reflux of the affected vertebral artery disappears, thus eliminating subclavian artery blood theft, with little injury, fast recovery and good effect. It is the preferred method of treatment at present.
4.Surgical treatment: Intraluminal intervention is unsuccessful, or stent occlusion can be considered for surgery, such as thromboendarterectomy, artificial vascular bypass surgery, transposition surgery, etc.
[Prognosis] Surgery and endoluminal treatment can achieve good results, and most of the cases will have radial artery and blood pressure on the affected side soon after surgery.