Subclavian steal syndrome. A review of 59 consecutive cases.

Subclavian steal syndrome results from reversal of flow through the vertebral artery from occlusion or stenosis of the proximal subclavian or 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 ever, result in permanent neurological damage in and of themselves. A significant percentage of patients will have concomitant extracranial atherosclerotic disease present. Visual disturbances and transient paralysis occur more often in patients with coexistent carotid disease. Carotid artery endarterectomy should be performed first in these patients and will likely resolve all symptoms. Carotid subclavian by-pass using a PTFE graft conduit remains the procedure of choice for patients suffering from disabling symptoms and can be performed with low operative risk and morbidity with excellent long term results.