Subclavian Artery Stenosis and Occlusion

Abstract

Subclavian and brachiocephalic artery stenosis and occlusion generally are found incidentally. Often the diagnosis is initially entertained on the basis of a differential between the upper extremity blood pressures. When symptomatic, the stenosis can cause symptoms of arm claudication, vertebral steal (“subclavian steal syndrome”), or angina (“coronary-subclavian steal syndrome”). A simple clinical maneuver to elicit steal symptoms, the Dieter test, is based upon the principle of hyperemic flow after blood pressure cuff inflation. The blood pressure cuff is inflated and held at suprasystolic pressures for at least a minute; it is then rapidly deflated – the ensuing hyperemic flow in the arm can elicit posterior circulation neurological symptoms or angina. It is important to not confuse dynamic left subclavian artery pseudostenosis (Dieter sign) which has neither symptoms nor indication for treatment with a true stenosis.

In this chapter, we present illustrative cases of upper extremity arterial disease. Arm claudication, subclavian steal, and coronary-subclavian steal syndrome are presented.