Ver el código de «Subclavian steal syndrome»

==Background==
*Stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm.  In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref>
*Increased incidence of left-sided subclavian stenosis
*The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms
[[File:Subclavian Steal Diagram.png|thumb|Subclavian Steal Diagram]]
===Etiology===
*Atherosclerosis
*Thoracic Outlet 
*Congenital Anomalies
*[[Takayasu arteritis]]

==Clinical Features==
===Symptoms in Upper Extremity===
*Pain
*Fatigue
*Coolness
*Paresthesias
*Numbness
===Neurologic Symptoms===
*Dizziness, Lightheadedness
*[[Vertigo]]
*[[Syncope]]

==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==
*[[Thoracic outlet syndrome]]
*[[Vertebrobasilar insufficiency]]
*[[Syncope]]
*[[Vertigo]]

{{Shoulder DDX}}

==Evaluation==
===Physical Exam Findings===
*Supraclavicular bruit, thrill
*Systolic BP in ipsilateral brachial artery is reduced compared to opposite side
*Ipsilateral radial pulse with decreased amplitude and delayed arrival
===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>===
*Routine testing for atherosclerosis: Lipid panel, Glucose
*Doppler ultrasound
*[[CXR]], [[ECG]]
*CTA, MRA
*Angiography

==Management==
===Medical Management===
#Treat atherosclerosis
#Antiplatelet therapy
#Anticoagulant therapy
===Surgical Management===
Indicated for symptomatic patients
#Angioplasty with endovascular stenting
#CEA (in patients with associated [[carotid stenosis]]) by increasing collateral blood flow
#Surgical bypass 

==Disposition==
*If symptomatic, admit with consults to Vascular Surgery, Neurology
*If incidental finding, consider close outpatient follow-up

==References==
<references/>

[[Category:Neurology]][[Category:Vascular]]