Subclavian steal syndrome
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Synopsis
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.
Codes
ICD10CM:G45.8 – Other transient cerebral ischemic attacks and related syndromes
SNOMEDCT:
15258001 – Subclavian steal syndrome
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Differential Diagnosis & Pitfalls
- TIA / stroke – posterior circulation
- Peripheral neuropathy
- Peripheral vascular 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
Last Updated:12/13/2018