Subclavian steal syndrome: an update.

The clinical findings in this series of 22 cases of subclavian steal syndrome showed a predominance of men (13:9), a mean age of 51 years, and a predominance of left subclavian artery obstruction. There was a blood pressure differential of more than 20 mm Hg and diminished pulses ipsilaterally in most. Main indications for surgical repair were transient neurologic symptoms. Twenty-one of our patients had surgical repair of the subclavian steal syndrome; six had concomitant carotid artery surgery. The most common surgical procedure performed consisted of a carotid subclavian bypass graft. One patient had only carotid revascularization; 19 patients have had good long-term results. One patient, with tetralogy, died and three had complications. The asymptomatic or mildly symptomatic patient may be given a trial of medical treatment. Symptomatic patients can have extrathoracic bypass with a very low risk. Surgery is indicated if significant associated carotid lesions are present.