Subclavian Steal Syndrome, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Subclavian Steal Syndrome, Diagnosis and Treatment and Related Diseases
Sub-clavian steal syndrome is a syndrome of symptoms linked to arterial insufficiency in the vertebral artery branch of the sub-clavian artery stemming from flow reversal, due to obstructive disease in the sub-clavian artery proximal to that vertebral artery branch.
To put it simply:
If there is obstruction in the left sub-clavian artery, there is no blood flow in the left vertebral artery to the brain and arm. Both the brain and arm may be affected.
Blood from the right vertebral artery then enters left vertebral artery and flows back to supply the left arm, instead of going to the brain.
While such a blockage of blood circulation in the neck can cause the blood flow in the opposite direction in the vertebral artery (from the brain), this results in the blood stolen from the brain and can cause disturbances in the brain's blood circulation and manifest itself as a drop attack.
The syndrome can cause symptoms such as episodes of acute vertigo.
It can also produce discomfort in the arm.
Classification
The sub-clavian steal phenomenon has been typically featured either by:
1. The territory from which the blood is “stolen” or
2. The severity of hemodynamic disturbances in the vertebral artery.
The severity is classified into 3 stages or grades:
1. Grade I (pre-sub-clavian steal): reduced antegrade vertebral flow,
2. Grade II (intermittent/partial/latent): alternating flow – antegrade flow in the diastolic phase and retrograde flow in the systolic phase,
3. Stage III (permanent/advanced): permanent retrograde vertebral flow.
A recent study has shown that the prevalence of a complete steal increases with higher arm blood pressure differentials (PD).
The study discovered that an arm PD >40 mm Hg was linked with significantly higher incidence of partial and complete steal, with a higher proportion of the latter.
Causes:
1. Atherosclerosis is the most frequent cause of sub-clavian stenosis and steal syndromes
2. Large artery vasculitis, thoracic outlet syndrome, and stenosis after surgical repair of aortic co-arctation or tetralogy of Fallot are other likely causes.
3. Congenital anomalies, such as a right-sided aortic arch with an isolated left sub-clavian artery, can also cause sub-clavian narrowing and steal syndromes
More unusual causes of sub-clavian steal are:
1.Takayasu's arteritis (large artery vasculitis),
2.Injury after surgery or radiation therapy,
3.Tumor of the chest cavity (mediastinal tumors),
4.Damage to blood vessel wall and
5.Anatomical anomalies of blood vessels.
Symptoms
Sub-clavian stenoses are most often asymptomatic
Vertebrobasilar insufficiency manifests typically as “drop attacks” but may also present as:
1. Dizziness,
2. Diplopia,
3. Nystagmus,
4. Tinnitus or even hearing loss.
Decreasing circulation to the arm can be presented as:
1. Weakness,
2. Pain through the use of the arm,
3. Tingling sensation or
4. Coldness in the arm.
Diagnosis
By evaluating blood pressure of both arms, the doctor will find a lower blood pressure on one side.
There will also be decreased or absent pulse in the wrist of the same arm.
The non-invasive Color-coded Doppler or transcranial Doppler ultrasonography is now regarded as the screening tool for sub-clavian steal
Treatment
When the sub-clavian steal syndrome has no or only scanty symptoms, a wait and watch treatment is indicated
When there are distressing symptoms, the patient should be assessed for surgery to widen the stricture of a vessel such as endovascular stenting or sub-clavian bypass surgery
Angioplasty and stenting is the favored surgical choice due to high success rates and low risks.

TABLE OF CONTENT
Introduction
Chapter 1 Subclavian Steal Syndrome
Chapter 2 Causes
Ch

• Language: English
• Publisher: Kenneth Kee
• Release date: Mar 28, 2019
• ISBN: 9780463073544

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Subclavian Steal Syndrome,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2019 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Subclavian Steal Syndrome, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Subclavian Steal Syndrome)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Sub-clavian steal syndrome

What is Sub-clavian steal syndrome?

Sub-clavian steal syndrome is a syndrome of symptoms linked to arterial insufficiency in the vertebral artery branch of the sub-clavian artery stemming from flow reversal, due to obstructive disease in the sub-clavian artery proximal to that vertebral artery branch.

To put it simply: If there is obstruction in the left sub-clavian artery, there is no blood flow in the left vertebral artery to the brain and arm. Both the brain and arm may be affected.

Blood from the right vertebral artery then enters left vertebral artery and flows back to supply the left arm, instead of going to the brain.(refer diagram below)

The affected Sub-clavian artery gives out a branch going up to the same side of the brain (vertebral artery), and the rest of the artery runs down the same side of the person's arm.

While such a blockage of blood circulation in the neck can cause the blood flow in the opposite direction in the vertebral artery (from the brain), this results in the blood stolen from the brain and can cause disturbances in the brain's blood circulation and manifest itself as a drop attack.

The syndrome can cause symptoms such as episodes of acute vertigo.

It can also produce discomfort in the arm.

Classification

The sub-clavian steal phenomenon has been typically featured either by:

1. The territory from which the blood is stolen or

2. The severity of hemodynamic disturbances in the vertebral artery.

The territories are classified as:

1. Vertebral-vertebral,

2. Carotid-basilar,

3. External carotid-basilar, or

4. Carotid-sub-clavian.

The severity is classified into 3 stages or grades:

1. Grade I (pre-sub-clavian steal): reduced antegrade vertebral flow,

2. Grade II (intermittent/partial/latent): alternating flow – antegrade flow in the diastolic phase and retrograde flow in the systolic phase,

3. Stage III (permanent/advanced): permanent retrograde vertebral flow.

A recent study has shown that the prevalence of a complete steal increases with higher arm blood pressure differentials (PD).

The study discovered that an arm PD >40 mm Hg was linked with significantly higher incidence of partial and complete steal, with a higher proportion of the latter.

All the patients under study who had no identified steal on ultrasound had a PD <40 mm Hg.

This corresponds to an earlier finding who reported a modest correlation between vertebral arterial waveforms and the blood pressure differentials in patients with sub-clavian steal syndrome.

Incidence

The disorder is not rare.

Once thought to be rare, the emergence of new imaging techniques has dramatically improved its diagnosis and prevalence.

It happens most often in people over 50 years and is slightly more frequent in men than in women.

The