SUBCLAVIAN STEAL SYNDROME - A REVIEW OF 59 CONSECUTIVE CASES

Subclavian steal syndrome results from reversal of flow through the ve rtebral artery from occlusion or stenosis of the proximal subclavian o r brachiocephalic artery. The resulting ''steal'' phenomenon leads to the common symptoms of vertigo, syncope, and intermittent claudication of the involved upper extremity. However, these symptoms rarely, if e ver, result in permanent neurological damage in and of themselves. A s ignificant percentage of patients will have concomitant extracranial a therosclerotic disease present. Visual disturbances and transient para lysis occur more often in patients with coexistent carotid disease. Ca rotid artery endarterectomy should be performed first in these patient s and will likely resolve all symptoms. Carotid subclavian by-pass usi ng a PTFE graft conduit remains the procedure of choice for patients s uffering from disabling symptoms and can be performed with low operati ve risk and morbidity with excellent long term results.