58-year-old man presenting with claudication

 

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Doctor's Information

Name :  Hamidreza
Family :Haghighatkhah
Affiliation : Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree: Associate professor of Radiology
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Hussein Soleiman Tabar

 

Patient's Information

Gender :  Male
Age :  58

 

Case Section

Interventional Radiology

 

Clinical Summary

-year-old man presenting with claudication of left upper extremity

 

 

Imaging Procedures and Findings

On arch aortogram (image1) left subclavian artery is not visible, meaning total occlusion at its origin. On image 2 left vertebral and subclavian arteries are filled in venous phase (simultaneous to jugular vein). On image 3 (selective left common carotid arteriogram) vertebral and subclavian arteries are not filled, which could be due to hypoplastic P.com arteries. On selective innominate arteriogram (the last image) left vertebral and subclavian arteries are opacified, meaning that the steal is from right vertebral artery.

 

Discussion

Subclavian steal syndrome is a condition caused by a proximal stenosis or occlusion of the subclavian artery with retrograde flow in the vertebral artery in order to supply blood to the upper limb. The blood originates from the contralateral vertebral or either carotid artery via the circle of Willis. The most frequent causes of this syndrome are atherosclerosis and Takayasus arteritis. It may also occur in children with cyanotic heart disease after creation of a subclavian to pulmonary anastamosis (Blalock Taussig shunt). Arch aortography discloses stenosis or occlusion of the subclavian or innominate artery proximal to the origin of the vertebral artery and delayed retrograde opacification of the ipsilateral vertebral artery with reconstitution of the distal subclavian artery. Contrast-enhanced MRA may also display these features.

 

Final Diagnosis

Subclavian steal syndrome

 

References

medcyclopaedia.com/library/topics/volume_v_2/s/subclavian_steal_syndrome.aspx?s=subclavian+steal&mode=1&syn=&scop=

 

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