Subclavian Steal Syndrome Workup

  • Author: Kenneth E McIntyre Jr, MD; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Mar 27, 2012
 

Laboratory Studies

Following an adequate physical examination, a routine battery of laboratory studies should be ordered to examine the risk factors for atherosclerosis. These tests should include a fasting lipid profile and blood glucose.

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Imaging Studies

  • Duplex ultrasonography
    • Duplex ultrasonography is the most important test of the extracranial carotid and vertebral arteries as well as the subclavian artery.
    • Duplex ultrasonography can demonstrate retrograde blood flow in the vertebral artery and any significant occlusive lesions of the carotid arteries in the neck. Subclavian steal syndrome is now most commonly diagnosed during Doppler ultrasound (US) examination of the neck arteries.[9]
    • Searching for significant lesions in the ipsilateral carotid artery is important. If brachial artery pressures are significantly decreased (>20%) compared with the contralateral side, perform arch aortography to further define the problem and plan for operative or interventional repair.
    • The ultrasound probe is usually inadequate for satisfactorily imaging the proximal subclavian artery.
    • CT angiography
      • This test uses iodinated contrast material and gives excellent anatomical detail concerning the location of the arterial lesions.
      • No arterial puncture is required.
      • However, if endovascular treatment is considered, then conventional 4-vessel arteriography is more appropriate, since the diagnostic study as well as the treatment can be performed at the same time.
  • Four-vessel cerebral angiography
    • This test can define the problem anatomically, demonstrating retrograde blood flow in the vertebral artery and associated proximal occlusive subclavian artery lesions.
    • In addition, arteriography serves as a road map for possible repair (surgical vs endovascular) of the subclavian artery.
  • Chest radiography: Chest x-ray films are used to look for unusual causes of subclavian artery obstruction (eg, cervical rib).
  • Magnetic resonance angiography: This modality has become an alternative to conventional angiography for the assessment of subclavian steal, especially in those patients with renal dysfunction. Unfortunately, however, MRA often overestimates the degree of arterial obstruction and is associated with a higher degree of false-positive studies.

For more information on imaging studies, please see the eMedicine Radiology topic Subclavian Steal Syndrome.

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Other Tests

ECG: Since many of these patients have concomitant ischemic heart disease, an ECG should be performed.

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Contributor Information and Disclosures
Author

Kenneth E McIntyre Jr, MD  Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine; Chief, Surgical Service, Chief, Vascular Surgery, Veterans Administration of Southern Nevada

Kenneth E McIntyre Jr, 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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center Program Director, Vascular Surgery Residency

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

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Irregular proximal subclavian stenosis.
Retrograde blood flow from the left vertebral artery into the left subclavian artery in a patient with subclavian steal syndrome.
Successful stent treatment of subclavian stenosis as seen in the previous image with restored antegrade flow into the vertebral artery.
 
 
 
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