The investigation of subclavian artery steal syndrome by color-coded duplex ultrasound: review of the literature and some case presentation of studies

Abstract

The subclavian artery steal syndrome (SSS) is characterized by the hemodymanic phenomenon of blood
flow reversal in the vertebral artery due to a significant stenosis or occlusion of the proximal subclavian
artery. Although the syndrome is relatively common, especially in patients with cardiovascular risk factors,
its recognition remains low, mainly because of a weak clinical suspicion but also because of its rare
symptomatic expression. We will here attempt a brief review of the syndrome and present subsequently
some case-studies from our institution. During a period of 4 months SSS was diagnosed by means of
color-coded duplex ultrasound in 14 patients out of 500 consecutive examinations, and in all the cases
its presence was confirmed by CT or MRI angiography. Three symptomatic patients with SSS (21%) were
detected, whereas a clear indication for interventional treatment was present in only one. Given the fact
that SSS can remain clinically silent and that its clinical presentation is often atypical, a strong clinical
suspicion or a screening using color-coded duplex ultrasound is necessary for its diagnosis. If detected, SSS should always be accompanied by a detailed cardiovascular workup.