Subclavian steal syndrome describes a temporary or chronic partial or complete occlusion of the arteries responsible for blood flow to the brain and upper extremities.
What is subclavian steal syndrome?
Subclavian steal syndrome is decreased blood flow to the arteries responsible for supplying blood to the upper extremities and brain. On the left side, the upper portion of the shoulder girdle artery, called the subclavian artery, is affected. This case occurs more frequently. On the right side, there are circulatory disturbances in the truncus brachiocephalicus. The circulatory disturbance is caused by temporary occlusion or severe narrowing of the artery. As a result, serious diseases may occur, which is why subclavian steal syndrome must be treated without fail. At best, a healthy lifestyle prevents the conditions that lead to subclavian steal syndrome.
Causes
When subclavian steal syndrome occurs, it can have several causes. First, subclavian steal syndrome can be caused by arteriosclerosis. Arteriosclerosis refers to a condition in which deposits of blood fats, connective tissue, thrombi, and small amounts of calcium occur in the arteries. In common parlance, arteriosclerosis is therefore also referred to as hardening of the arteries. Another possible cause of subclavian steal syndrome is Takayasu arteritis, an autoimmune disease that results in inflammation of the aorta, which in the worst cases ends in destruction of the vessel walls.
Symptoms, complaints, and signs
Subclavian steal syndrome is characterized by both neurologic and arm symptoms. However, the overall symptomatology is dependent on the extent of decrease in blood flow through the arteries supplying the brain. There are asymptomatic, seizure-like, and continuous courses of the disease. When flow dynamics in the brachial artery are normal, no symptoms occur. In the cases of short-term interruption of blood flow, there is a sudden symptomatology that starts during arm movements. In some patients, blood flow through the arteries supplying the brain is permanently reduced. This leads to chronic symptoms. Neurological symptoms are characterized by seizure-like dizziness and seizure-like loss of consciousness, among other symptoms. Sudden attacks of falling while fully conscious are also possible. Loss of tone of the lower extremities takes place. Visual disturbances, ringing in the ears, sensory disturbances, coordination disorders of movement or speech and swallowing disorders are also observed as part of the neurological deficits. In addition to the neurological deficits, there are often also arm-related symptoms, which usually only appear on one side. These affect the arms and appear there in the form of paresthesias (tingling, numbness), pallor, cold sensations as well as pain. In most cases, only part of the symptoms occur. Only in severe forms of the disease does the patient suffer permanently from all symptoms. The complaints often intensify during arm movements.
Diagnosis and course
When subclavian steal syndrome is associated with a short-lasting interruption of blood supply, asymptomatic abnormalities usually occur, making it difficult to diagnose subclavian steal syndrome. However, if a permanent subclavian steal syndrome occurs, neurological deficits such as sudden dizziness and even fainting, sensory disturbances, visual disturbances and minor strokes are the main factors that raise the suspicion of subclavian steal syndrome. The arms also experience mild tingling or itching to severe pain. The arms additionally often lose color and feel cold. If these symptoms occur and subclavian steal syndrome is suspected, a physician can diagnose subclavian steal syndrome by taking a comprehensive history followed by an extensive physical examination. Blood pressure and pulse as well as flow sounds provide initial clues. Subclavian steal syndrome can then be clearly identified with imaging techniques such as duplex sonography or angiography. If subclavian steal syndrome is not treated, it can lead to minor to severe strokes that can be fatal.Even if death does not result from failure to treat subclavian steal syndrome, severe damage and disability are possible if the brain is not supplied with sufficient blood and thus oxygen for too long as a result of the circulatory problems. Therefore, at the slightest signs of subclavian steal syndrome, it is imperative to consult a physician so that he or she can either rule out subclavian steal syndrome or begin appropriate treatment immediately.
Complications
In the worst case scenario, subclavian steal syndrome can lead to death in the affected individual. However, this case occurs only if the disease is not treated. The affected person primarily suffers from severe dizziness and furthermore also from unconsciousness. Ringing in the ears and also various visual disturbances occur, although these are only temporary. Sensory disturbances and paralysis can also occur in subclavian steal syndrome and have a very negative effect on the patient’s quality of life. There is also pain and pallor in the affected person. Patients with subclavian steal syndrome often feel cold and also suffer from tingling in the extremities. If the condition is not treated in time, the internal organs may also be damaged. The life expectancy of the patient may also be reduced by the syndrome. Usually, no particular complications occur during the treatment of this disease. With the help of surgical interventions, the symptoms can be alleviated. Subsequent treatment with the help of medications is also usually necessary in subclavian steal syndrome. Furthermore, a healthy lifestyle has a very positive effect on the disease and can prevent further complaints.
When should you see a doctor?
The affected person is definitely dependent on a visit to a doctor in the case of subclavian steal syndrome. There can be no self-healing in this disease, and if left untreated, the symptoms can worsen significantly and, in the worst case, lead to the death of the affected person. Therefore, a doctor should be consulted at the first symptoms and signs of subclavian steal syndrome to prevent further complications. A doctor should be consulted if the affected person suffers from sudden severe dizziness. This may even lead to a loss of consciousness. Furthermore, disturbances in sensitivity or discomfort when swallowing also indicate subclavian steal syndrome and should be examined by a doctor immediately. Severe pallor or a permanent feeling of coldness are also not uncommon indications of this disease. Many sufferers also experience sudden visual complaints. Subclavian steal syndrome should usually be treated immediately by an emergency physician or in a hospital. In some cases, the affected person may also first see a general practitioner or a cardiologist. It cannot be universally predicted whether decreased life expectancy will result from subclavian steal syndrome.
Treatment and Therapy
Subclavian steal syndrome is treated depending on the associated symptoms. Mild vasoconstriction can be repaired by a procedure called angioplasty. In this procedure, the vessels are widened again using so-called balloon catheters, which are often inserted into the vessels via the groin. In addition, so-called stents are often placed in the affected vessel. These expandable metal or plastic tubes also ensure that the blockage is removed and the vessel can once again be supplied with sufficient blood. In the case of severe vascular stenoses, on the other hand, a surgical intervention is often required in which a bypass is inserted. This is an artificial bypass of the section of the vessel in which the vasoconstriction is present.
Prevention
To prevent subclavian steal syndrome, all conditions that may result in arterial occlusion must be prevented. A healthy diet and lifestyle are particularly effective. Smoking, in particular, can cause arterial blockages, disrupt or completely cut off blood flow, and lead to subclavian steal syndrome. Other risk factors that promote subclavian steal syndrome and should therefore be avoided are an excessively high-fat diet and obesity, high blood pressure and elevated cholesterol levels.Therefore, a low-fat diet with adequate exercise are also good ways to prevent subclavian steal syndrome.
Follow-up
Because subclavian steal syndrome is a congenital and therefore also genetic disease, it usually cannot be cured on its own. Affected persons are therefore dependent on examination and treatment by a physician. In this context, the measures and options for aftercare are also usually significantly limited. Early diagnosis can prevent the occurrence of further symptoms and complications. If the affected person or parents wish to have children, genetic testing and counseling is recommended to prevent the recurrence of this disease. The treatment of subclavian steal syndrome is usually carried out through the measures of physiotherapy or physiotherapy. In this process, the affected person can also repeat many of the exercises in their own home and thus accelerate the healing process. Regular check-ups and examinations by a doctor are also very useful in order to monitor the symptoms in the long term. As a rule, subclavian steal syndrome does not limit the life expectancy of the affected person. Contact with other sufferers of the disease can also be very useful, as it can lead to an exchange of information, which facilitates the daily life of the affected person.
What you can do yourself
Subclavian steal syndrome usually requires invasive treatment. However, sufferers can also take some steps themselves to alleviate the underlying circulatory problems. First, it is important to make lifestyle changes. Patients must not smoke or drink and must eat a low-fat, balanced diet. It is also important to exercise regularly, thereby stimulating circulation in the limbs. In case of numbness or other signs of circulatory disorders, the doctor should be informed. After an operation in which, for example, a bypass is performed or the ailment is invasively removed, rest and sparing are the order of the day. It is best for the patient to discuss the important measures with the attending physician. If symptoms reappear that indicate further circulatory problems, the doctor must be informed. The risk of arterial occlusion can be additionally reduced by accompanying measures such as massage or exercise. However, because subclavian steal syndrome is a serious condition, close medical monitoring is also always needed. Patients must consult with their primary care physician and an internist, especially if bypass has been performed.
