Extracranial Steal Syndromes from Disease of the Aortic Branches

Occlusive disease in the subclavian arteries or the innominate artery can give rise to extracranial steal syndromes. The most defined syndrome is the subclavian steal syndrome. In this condition, occlusive disease in the proximal subclavian artery can lead to a siphoning of blood away from the brain by a reversal of flow down the vertebral artery on the affected side to the ischemic limb. The pulse and blood pressure are diminished in the affected limb. The symptoms may include headache, vertebrobasilar ischemia, and limb claudication, often precipitated by exercise. A bruit may be heard over the subclavian artery. The limb may become cyanotic if it is held above the level of the heart. It should be noted that a majority of persons with subclavian steal detected by noninvasive techniques have no neurological symptoms.y

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