INVESTIGATION AND MANAGEMENT OF SUBCLAVIAN STEAL SYNDROME

Patients with subclavian steal syndrome present with symptoms of verte brobasilar ischaemia. Although angiography has traditionally been used to confirm the diagnosis of subclavian steal and plan reconstructive surgery in symptomatic patients, duplex ultrasonography now offers rap id diagnosis and also permits examination of the other extracranial ve ssels. The treatment of subclavian steal syndrome is surgical. Extra-a natomic bypass procedures are used to increase inflow to the subclavia n artery, abolishing the steal phenomenon. Carotid-subclavian bypass o r transposition and subclavian-subclavian or axilloaxillary bypass are the procedures of choice; selection is governed by the presence of co existent carotid artery disease. Percutaneous transluminal balloon ang ioplasty of the subclavian artery is an alternative treatment, althoug h the long-term patency rate is inferior to that of extra-anatomic byp ass.