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Subclavian steal syndrome
Other Resources UpToDate PubMed

Subclavian steal syndrome

Contributors: Carolyn Zyloney MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Subclavian steal syndrome is retrograde blood flow into the vertebral artery due to occlusion or stenosis of the ipsilateral subclavian artery proximal to the origin of the vertebral artery. It is most commonly due to atherosclerotic vascular disease. Rarely, it can be due to vasculitis, aortic dissections, external compression of the subclavian artery, and congenital anatomic anomalies of the vascular system.

Prevalence of subclavian steal syndrome is approximately 1%-6%. It is most common in patients over 50 years of age, and males are affected twice as often as females. The most common risk factors for development of this syndrome include smoking, hyperlipidemia, hypertension, and diabetes.

Patients are often asymptomatic, and only 5% of patients experience neurological symptoms. Symptomatic patients typically have a decreased pulse or blood pressure in the affected arm. Symptoms may include arm pain or numbness, particularly after vigorous exercise of the arm. The left arm is affected 4 times as often as the right arm. Some patients may have transient vertebrobasilar insufficiency symptoms including dizziness, vertigo, syncope, dysarthria, diplopia, or vision loss due to posterior circulation ischemia.

Most patients can be managed conservatively; however, surgical revascularization may be needed to restore anterograde blood flow. Prognosis is generally good.


G45.8 – Other transient cerebral ischemic attacks and related syndromes

15258001 – Subclavian steal syndrome

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Differential Diagnosis & Pitfalls

  • Transient ischemic attacks / Cerebral stroke – posterior circulation
  • Peripheral neuropathy
  • Peripheral arterial disease
  • Musculoskeletal injury
  • Myopathy
  • Thoracic outlet syndrome
  • Takayasu arteritis
  • Arteriovenous (AV) fistula occlusion (in patients on dialysis)

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Last Reviewed:12/03/2018
Last Updated:12/13/2018
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Subclavian steal syndrome
A medical illustration showing key findings of Subclavian steal syndrome : Dizziness, Arm pain, Diplopia, Syncope, Vertigo, Monoparesis of arm, Arm paresthesias
Copyright © 2024 VisualDx®. All rights reserved.