Diseases of the arteries of the upper limb

Abstract

In 1961 Reivich et al [1] described for the first time a syndrome caused by stenooccluding pathological processes involving the subclavian artery proximal to the emergence of the ipsilateral vertebral artery, and characterized by the activation of specific collateral pathways of the ascending aorta; that same year Fisher et al [2] named it ‘subclavian steal syndrome’. In this case the subclavian artery, stenosed or occluded at the origin, is supplied with blood from the ipsilateral vertebral artery with a reverse flow direction [3]. This allows valid compensation for hemodynamic disorders in the brachial area, at the expense, however, of the encephalic region from which blood diverted to the subclavian artery is subtracted. This phenomenon was first noted in 1886 [4], after a subclavian artery ligation for a traumatic aneurysm: the vertebral artery was ligated and the patient survived ten years. Later contributions on this subject have not only shown that subclavian steal syndrome is a reliable indicator of severe subclavian artery stenosis, though the syndrome itself is relatively benign, but have also provided a more detailed etiological framework showing that alongside arteritic, traumatic, congenital and iatrogenic forms exist others — which occur more frequently — of atherosclerotic origin [5] (Table 17.1).