History and Physical Examination
A patient with an acute occlusion presents with a cold, painful, pulseless upper extremity. Axillary, brachial, and radial pulses are generally absent. When the occlusion is secondary to atherosclerotic changes, various prodromes and manifestations may be observed.
The patient may present with no symptoms or may have upper-extremity claudication secondary to exertion. If the condition has precipitated a steal syndrome, no symptoms are typically present. The examining physician should be aware of the rare presentation of various neurologic symptoms and findings that may be associated with the steal syndromes, including syncope, vertigo, ataxia, sensory loss, visual changes, and stroke, depending on the vessels involved in the steal. The affected upper extremity may or may not demonstrate diminished pulses. Blood pressure differences between affected and unaffected sides may be noted.
Potential complications of subclavian artery thrombosis secondary to atherosclerotic disease include distal embolization to the digits and neurologic symptoms, including stroke secondary to a steal syndrome. If the subclavian artery thrombosis is secondary to thoracic outlet problems, subclavian vein thrombosis can occur as well.  Accompanying neurologic symptoms resulting from brachial plexus compression can also be associated with the syndrome.
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