454-188 | Left Subclavian Artery Kinking, an Unusual Cause of Partial Subclavian Steal Syndrome-Left Subclavian Artery Kinking, an Unusual Cause of Partial Subclavian Steal Syndrome

Left Subclavian Artery Kinking, an Unusual Cause of Partial Subclavian Steal Syndrome

Pdf Summary

This case report describes a 63-year-old female patient with subclavian steal syndrome diagnosed by color Doppler ultrasound. However, the ultrasound analysis of the cervical vessels did not show an apparent cause for the subclavian steal. A computed tomographic angiogram of the thoracic aorta revealed that the patient had left subclavian artery kinking proximal to the origin of the vertebral artery, which was an uncommon finding and the cause of the subclavian steal. The patient opted for conservative management with regular follow-up.<br /><br />Subclavian steal syndrome is typically associated with stenotic lesions in the ipsilateral subclavian artery. However, in this case, the subclavian steal was caused by the abnormal kinking of the left subclavian artery. The kinking of the artery likely resulted from the abnormal development of the brachiocephalic artery.<br /><br />The article discusses the prevalence of subclavian steal syndrome, which has been found in approximately 5.4% of patients undergoing arterial Doppler of the extracranial vessels. It also provides a brief history of the term "subclavian steal syndrome" and the description of retrograde vertebral artery flow in patients with subclavian artery occlusion.<br /><br />The ultrasound findings showed partially reversed or alternating flow in the left vertebral artery, which was intensified by left upper extremity exercise. The computed tomographic angiogram provided a 3-dimensional visualization of the left subclavian artery kinking.<br /><br />Overall, this case highlights the importance of considering uncommon causes for subclavian steal syndrome and the significance of imaging modalities such as color Doppler ultrasound and computed tomographic angiography in the diagnosis and management of the condition.

Keywords

subclavian steal syndrome

color Doppler ultrasound

computed tomographic angiogram

left subclavian artery

vertebral artery

conservative management

stenotic lesions

brachiocephalic artery

prevalence

diagnosis and management