Subclavian steal syndrome - Revision history

ClaireLewis at 16:19, 3 October 2019

2019-10-03T16:19:01Z

← Older revision		Revision as of 16:19, 3 October 2019
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	===Etiology===		===Etiology===
	*Atherosclerosis		*Atherosclerosis
	*Thoracic ~~Outlet~~		*[[Thoracic outlet obstruction]]
	*Congenital ~~Anomalies~~		*Congenital anomalies
	*[[Takayasu arteritis]]		*[[Takayasu arteritis]]

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	===Symptoms in Upper Extremity===		===Symptoms in Upper Extremity===
	*Pain		*Pain
	*Fatigue		*[[Fatigue]]
	*Coolness		*Coolness
	*Paresthesias		*[[Paresthesias]]
	*Numbness		*[[Numbness]]
	===Neurologic Symptoms===		===Neurologic Symptoms===
	*[[Dizziness]], Lightheadedness		*[[Dizziness]], Lightheadedness
	*[[Vertigo]]		*[[Vertigo]]
	*[[Syncope]]		*[[Syncope]]
			===Physical Exam Findings===
			*Supraclavicular bruit, thrill
			*Systolic BP in ipsilateral brachial artery is reduced compared to opposite side
			*Ipsilateral radial pulse with decreased amplitude and delayed arrival
	==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==		==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==
	*[[Thoracic outlet syndrome]]		*[[Thoracic outlet syndrome]]
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	==Evaluation==		==Evaluation==
	~~===Physical Exam Findings===~~
	*Supraclavicular bruit, thrill
	*Systolic BP in ipsilateral brachial artery is reduced compared to opposite side
	*Ipsilateral radial pulse with decreased amplitude and delayed arrival
	===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>===		===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>===
	*Routine testing for atherosclerosis: Lipid panel, Glucose		*Routine testing for atherosclerosis: Lipid panel, Glucose
	*Doppler ultrasound		*Doppler [[ultrasound]]
	*[[CXR]], [[ECG]]		*[[CXR]], [[ECG]]
	*CTA, MRA		*CTA, MRA

ClaireLewis: /* Neurologic Symptoms */

2019-09-19T17:59:11Z

Neurologic Symptoms

← Older revision		Revision as of 17:59, 19 September 2019
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	*Numbness		*Numbness
	===Neurologic Symptoms===		===Neurologic Symptoms===
	*Dizziness, Lightheadedness		*[[Dizziness]], Lightheadedness
	*[[Vertigo]]		*[[Vertigo]]
	*[[Syncope]]		*[[Syncope]]

ClaireLewis: /* Medical Management */

2019-09-19T17:58:58Z

Medical Management

← Older revision		Revision as of 17:58, 19 September 2019
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	===Medical Management===		===Medical Management===
	#Treat atherosclerosis		#Treat atherosclerosis
	#Antiplatelet therapy		#[[Antiplatelet]] therapy
	#Anticoagulant therapy		#[[Anticoagulant]] therapy

	===Surgical Management===		===Surgical Management===
	Indicated for symptomatic patients		Indicated for symptomatic patients

Devin Smith: /* Etiology */

2017-02-20T07:28:40Z

Etiology

← Older revision		Revision as of 07:28, 20 February 2017
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	*Thoracic Outlet		*Thoracic Outlet
	*Congenital Anomalies		*Congenital Anomalies
	*Takayasu~~'s Arteritis~~		*[[Takayasu arteritis]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. */

2016-09-24T07:12:41Z

Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141.

← Older revision		Revision as of 07:12, 24 September 2016
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	==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==		==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==
	*[[Thoracic outlet syndrome]]		*[[Thoracic outlet syndrome]]
	*[[~~Verebrobasilar Insufficiency~~]]		*[[Vertebrobasilar insufficiency]]
	*[[Syncope]]		*[[Syncope]]
	*[[Vertigo]]		*[[Vertigo]]

Rossdonaldson1: /* Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. */

2016-09-24T07:10:23Z

Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141.

← Older revision		Revision as of 07:10, 24 September 2016
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	==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==		==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==
	*Thoracic ~~Outlet Syndrome~~		*[[Thoracic outlet syndrome]]
	*[[Verebrobasilar Insufficiency]]		*[[Verebrobasilar Insufficiency]]
	*[[Syncope]]		*[[Syncope]]

Rossdonaldson1: /* Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. */

2016-09-24T07:10:08Z

Differential Diagnosis De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141.

← Older revision		Revision as of 07:10, 24 September 2016
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	*[[Syncope]]		*[[Syncope]]
	*[[Vertigo]]		*[[Vertigo]]

			{{Shoulder DDX}}

	==Evaluation==		==Evaluation==

ClaireLewis at 22:50, 10 September 2016

2016-09-10T22:50:36Z

← Older revision		Revision as of 22:50, 10 September 2016
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	==Background==		==Background==
	*~~A stenosis~~ of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref>		*Stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref>
	*~~There is an increased~~ incidence of left-sided subclavian stenosis		*Increased incidence of left-sided subclavian stenosis
	*The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms		*The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms
	[[File:Subclavian Steal Diagram.png\|thumb\|Subclavian Steal Diagram]]		[[File:Subclavian Steal Diagram.png\|thumb\|Subclavian Steal Diagram]]
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	*Routine testing for atherosclerosis: Lipid panel, Glucose		*Routine testing for atherosclerosis: Lipid panel, Glucose
	*Doppler ultrasound		*Doppler ultrasound
	*~~Chest x-ray~~, ECG		*[[CXR]], [[ECG]]
	*CTA, MRA		*CTA, MRA
	*Angiography		*Angiography
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	Indicated for symptomatic patients		Indicated for symptomatic patients
	#Angioplasty with endovascular stenting		#Angioplasty with endovascular stenting
	#CEA (in patients with associated carotid ~~disease~~) by increasing collateral blood flow		#CEA (in patients with associated [[carotid stenosis]]) by increasing collateral blood flow
	#Surgical bypass		#Surgical bypass

Neil.m.young: Text replacement - "EKG" to "ECG"

2016-08-29T12:39:32Z

Text replacement - "EKG" to "ECG"

← Older revision		Revision as of 12:39, 29 August 2016
Line 36:		Line 36:
	*Routine testing for atherosclerosis: Lipid panel, Glucose		*Routine testing for atherosclerosis: Lipid panel, Glucose
	*Doppler ultrasound		*Doppler ultrasound
	*Chest x-ray, ~~EKG~~		*Chest x-ray, ECG
	*CTA, MRA		*CTA, MRA
	*Angiography		*Angiography

Neil.m.young at 11:53, 19 August 2016

2016-08-19T11:53:49Z

← Older revision		Revision as of 11:53, 19 August 2016
Line 1:		Line 1:
	==Background==		==Background==
	* A stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref>		*A stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref>
	* There is an increased incidence of left-sided subclavian stenosis		*There is an increased incidence of left-sided subclavian stenosis
	* The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms		*The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms

	[[File:Subclavian Steal Diagram.png\|thumb\|Subclavian Steal Diagram]]		[[File:Subclavian Steal Diagram.png\|thumb\|Subclavian Steal Diagram]]

	===Etiology===		===Etiology===
	* Atherosclerosis		*Atherosclerosis
	* Thoracic Outlet		*Thoracic Outlet
	* Congenital Anomalies		*Congenital Anomalies
	* Takayasu's Arteritis		*Takayasu's Arteritis

	==Clinical Features==		==Clinical Features==
	===Symptoms in Upper Extremity===		===Symptoms in Upper Extremity===
	* Pain		*Pain
	* Fatigue		*Fatigue
	* Coolness		*Coolness
	* Paresthesias		*Paresthesias
	* Numbness		*Numbness

	===Neurologic Symptoms===		===Neurologic Symptoms===
	* Dizziness, Lightheadedness		*Dizziness, Lightheadedness
	* [[Vertigo]]		*[[Vertigo]]
	* [[Syncope]]		*[[Syncope]]

	==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==		==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>==
	* Thoracic Outlet Syndrome		*Thoracic Outlet Syndrome
	* [[Verebrobasilar Insufficiency]]		*[[Verebrobasilar Insufficiency]]
	* [[Syncope]]		*[[Syncope]]
	* [[Vertigo]]		*[[Vertigo]]

	==Evaluation==		==Evaluation==

	===Physical Exam Findings===		===Physical Exam Findings===
	* Supraclavicular bruit, thrill		*Supraclavicular bruit, thrill
	* Systolic BP in ipsilateral brachial artery is reduced compared to opposite side		*Systolic BP in ipsilateral brachial artery is reduced compared to opposite side
	* Ipsilateral radial pulse with decreased amplitude and delayed arrival		*Ipsilateral radial pulse with decreased amplitude and delayed arrival

	===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>===		===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>===
	* Routine testing for atherosclerosis: Lipid ~~Panel~~, Glucose		*Routine testing for atherosclerosis: Lipid panel, Glucose
	* Doppler ~~Ultrasound~~		*Doppler ultrasound
	* Chest ~~XRay~~, EKG		*Chest x-ray, EKG
	* CTA, MRA		*CTA, MRA
	* Angiography		*Angiography

	==Management==		==Management==
			===Medical Management===
	===Medical ~~management~~===		#Treat atherosclerosis
	# Treat atherosclerosis		#Antiplatelet therapy
	# Antiplatelet ~~Therapy~~		#Anticoagulant therapy
	# Anticoagulant ~~Therapy~~		===Surgical Management===

	===Surgical ~~management~~===
	Indicated for symptomatic patients		Indicated for symptomatic patients
	# Angioplasty with ~~Endovascular Stenting~~		#Angioplasty with endovascular stenting
	# CEA (in patients with associated carotid disease) by increasing collateral blood flow		#CEA (in patients with associated carotid disease) by increasing collateral blood flow
	# Surgical ~~Bypass~~		#Surgical bypass

	==Disposition==		==Disposition==
	* If symptomatic, admit with consults to Vascular Surgery, Neurology		*If symptomatic, admit with consults to Vascular Surgery, Neurology
	* If incidental finding, consider close outpatient follow up		*If incidental finding, consider close outpatient follow-up

	==References==		==References==
	<references/>		<references/>

			[[Category:Neurology]][[Category:Vascular]]
	[[Category:Neurology]]