eMedicine Specialties > Vascular Surgery > Medical Topics

Subclavian Steal Syndrome: Follow-up

Author: Kenneth E McIntyre, MD, Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine
Contributor Information and Disclosures

Updated: Oct 29, 2009

Outcome and Prognosis

Patients with asymptomatic flow reversal in a vertebral artery have a benign natural history, and no specific treatment is required. With proximal subclavian artery occlusive disease, patients may first seek medical treatment for symptoms of exercise-induced arm pain rather than for neurologic symptoms associated with arm exercise Furthermore, if a patient has undergone coronary revascularization using a left internal mammary artery (LIMA) graft, new onset angina may herald proximal left subclavian stenosis. With subclavian steal syndrome, if neurologic symptoms do occur, they tend to be transient (ie, transient ischemic attack) and seldom lead to stroke.

The outcome for patients who have antegrade vertebral blood flow reestablished by either surgical revascularization or endovascular stenting of the diseased subclavian artery is highly favorable. The stroke risk from the procedure is low, and the long-term durability is excellent.

The operative mortality rate from transthoracic subclavian artery revascularization is substantially higher than for extrathoracic repair, mainly because of the morbidity associated with thoracotomy. Recognizing this problem, surgeons have virtually abandoned this approach in favor of extrathoracic revascularization, either carotid-subclavian bypass or subclavian transposition. The operative mortality rate for either of these extrathoracic procedures approaches zero. Moreover, the morbidity rate is very low.

The results of percutaneous subclavian angioplasty and/or stent placement are also excellent. Most authors document initial success rates of 91-100%, and the complication rate is reasonably low (3-17%). After successful stenting of the subclavian artery, the restenosis rate is 0-16% after 12-48 months follow-up. The technical success rate of subclavian angioplasty varies from 86-100%. The restenosis rate following subclavian angioplasty is 5-22% with follow-up from 28-60 months.

Future and Controversies

With recent improvements in angioplasty and stent placement techniques, surgery will probably have a smaller role for the treatment of subclavian steal syndrome in the future. Because the results of treatment for subclavian stenosis with angioplasty or stent placement are so good, surgery will likely be reserved for those patients who have had prior unsuccessful attempts at endovascular treatment. These unsuccessful cases usually involve a chronic subclavian occlusion of considerable length. In these cases, traversing the lesion with a guidewire is difficult, thus inducing a higher failure rate.

 


More on Subclavian Steal Syndrome

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Multimedia: Subclavian Steal Syndrome
References
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References

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Further Reading

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Keywords

subclavian steal syndrome, subclavian, subclavian vein, retrograde vertebral artery blood flow, proximal ipsilateral subclavian artery stenosis, proximal ipsilateral subclavian artery occlusion, atherosclerosis, atherosclerotic plaque, tobacco

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Contributor Information and Disclosures

Author

Kenneth E McIntyre, MD, Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine
Kenneth E McIntyre, MD is a member of the following medical societies: American College of Surgeons, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Southern Association for Vascular Surgery
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Lawrence Kaufman, MD, Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine
Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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