Subclavian steal syndrome and flow-related aneurysm - Another reason to treat

A 48-year-old woman presented with a symptomatic right subclavian steal syn drome due to proximal. subclavian artery stenosis. Anatomically the innomin ate artery was absent. Collateral circulation followed the vertebro-vertebr al pathway with reversal of blood flow in the ipsilateral vertebral artery. There was also multiple dilated intervertebral collaterals and an associat ed saccular aneurysm on one of them. Surgical carotid-subclavian transposit ion permitted relief of clinical symptoms, disappearance of collateral circ ulation and subtotal regression of the aneurysm. This spontaneous evolution confirmed the role of high-now in the pathogenesis of some aneurysms and t he habitually good prognosis of flow-related aneurysms with correction of t he cause. Arteriography still appears essential in diagnosis, pretherapeuti c assessment and sometimes post-treatment evaluation in subclavian steal sy ndrome.