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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2007 August;166(4):135-50

language: English, Italian

Subclavian steal “syndromes”

Pieragalli D. 1, Setacci C. 2, Di Perri T. 1, De Franco V. 1, Panti S. 1, Renzi N. 1, Bertucci G. 1, Auteri A. 1, Giubbolini M. 2, Pieraccini M. 2, Meini S. 1

1 Department of Internal Medicine and Immunology, Division of Internal Medicine, University of Siena, Siena, Italy;
2 Department of Vascular Surgery, University of Siena, Siena, Italy


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In 1959 Contorni described the “sindrome da emoderivazione cefalo-brachiale”, characterized by vertebral flow inversion omolaterally to a proximal subclavian artery’s occlusion; the definition “subclavian steal syndrome” was done by Reivich in 1961. The vascular steal happens consequently of a pre-vertebral subclavian stenosis-occlusion: more often the nature of lesion is atherosclerotic, but is possible an inflammatory, displastic or iatrogenic etiology. The prevalence in general population is 1,9%: lesions determining a steal represent the 1,5-3% of all arteriopaties. Risk factors associated are smoke, hypertension, diabetes, cerebrovascular and coronary disease, and peripheral arterial disease. Especially in conditions of increased metabolic request of upper limb may happens a blood distrainment of other districts, typically cerebral one through the inversion of vertebral flow, with neurological symptomatology. Moreover is possible a compensation to upper limb from other collateral circles: clinical importance of a steal such as the mammary-subclavian one is interesting in case of coronary bypass realized with internal mammary artery, because happens a coronary steal with ischemic symptomatology. Very frequently steal is asymptomatic. Besides classical vertebral-subclavian steal (permanent, intermittent, latent) is described the carotid-subclavian steal and the rarest coronary-subclavian steal. Is also described an aortic arch syndrome characterized by contemporary compromission of all supra-aortic trunks. It seems more correct talking about “syndromes” of subclavian steal. Angiography represented the diagnostic gold standard in prevision of operation; echo-color-Doppler, sensitized by compression test and reactive hyperemia test, can supply important anatomic and functional informations, but, at the moment, best informations are supplied by angio-TC and angio-RM.

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