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1.
Rev. bras. cir. cardiovasc ; 34(2): 136-141, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-990569

ABSTRACT

Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Subclavian Steal Syndrome/physiopathology , Vertebrobasilar Insufficiency/physiopathology , Blood Pressure/physiology , Endarterectomy, Carotid/methods , Postoperative Complications/etiology , Reference Values , Subclavian Steal Syndrome/complications , Vertebrobasilar Insufficiency/complications , Blood Pressure Determination/methods , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Stroke/etiology , Preoperative Period
2.
Article in Chinese | WPRIM | ID: wpr-772133

ABSTRACT

OBJECTIVE@#To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis.@*METHODS@#A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles.@*RESULTS@#In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, =0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; = 629.5, =0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) 7.7%(3/39);=8.603, =0.003).@*CONCLUSIONS@#SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.


Subject(s)
Hemodynamics , Humans , Regional Blood Flow , Physiology , Retrospective Studies , Subclavian Steal Syndrome , Vertebral Artery , Vertebrobasilar Insufficiency
3.
Yonsei Medical Journal ; : 462-466, 2017.
Article in English | WPRIM | ID: wpr-117394

ABSTRACT

Subclavian artery (SCA) perforation is a rare complication while performing SCA intervention. In our present report, a 73-year-old female, with stenosis of the left SCA and situs inversus, presented with exercise-induced left arm weakness. The SCA stenosis was treated with direct stenting with a balloon-expansible Express LD 10×25 mm stent. However, it caused iatrogenic SCA perforation and hemothorax. The perforation was sealed by endovascular repair with operator-modified Endurant II graft stent, which complicated with occlusion of left common carotid artery. And, the carotid artery was rescued by another stent. The graft stent, which was originally designed for abdominal aortic aneurysm, can be modified to suitable length and take as a rescue stent of large vessel with iatrogenic perforation. Due to strong radial force of graft stent, preservation of large side branches should been watched out.


Subject(s)
Aged , Aortic Aneurysm, Abdominal , Arm , Carotid Arteries , Carotid Artery, Common , Constriction, Pathologic , Female , Hemothorax , Humans , Situs Inversus , Stents , Subclavian Artery , Subclavian Steal Syndrome , Transplants
4.
ImplantNewsPerio ; 1(8): 1561-1569, nov.-dez. 2016. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-848540

ABSTRACT

Este relato de caso mostra os perigos que uma diferença significativa assintomática na pressão arterial pode trazer à Implantodontia. Paciente do sexo feminino com 75 anos de idade, com perdas de elementos dentais na região posterior de maxila, recebeu como plano de tratamento cirurgias de enxertia e posterior instalação de implantes. Exames pré-operatórios e avaliação cardiológica foram requisitados, sendo autorizadas as cirurgias. Dois atos cirúrgicos foram realizados sem intercorrências. Na terceira cirurgia, no pré-operatório, constatou-se uma diferença de pressão arterial entre os braços direito e esquerdo quando optou-se pelo cancelamento da cirurgia e novo encaminhamento com urgência ao cardiologista em posse do relatório clínico. A pressão arterial mais baixa no braço esquerdo era causada por uma estenose na artéria subclávia com risco aumentado para acidentes vasculares e morbidade cardíaca. Uma angioplastia foi realizada com a instalação de stent, medicações anti-hipertensivas foram mantidas e um antiagregante plaquetário foi introduzido. A paciente foi liberada para continuidade de seu tratamento, com orientações do cardiologista e cirurgião vascular a serem seguidas. Diante do ocorrido e das observações apontadas na literatura pesquisada, pôde-se concluir que o cirurgião terá um melhor panorama das condições físicas dos pacientes se na anamnese ele tomar como rotina a correta aferição da pressão arterial nos dois braços e, diante de qualquer anormalidade, fazer os encaminhamentos necessários para sua segurança e de seus pacientes.


This case report demonstrates how a significant difference at the interarm blood pressure can bring risks to implant dentistry. A 75 years-old female patient with loss of posterior maxillary teeth received a treatment planning grafting surgeries and further implant placement. The pre-operative exams and a cardiologic evaluation were requested, and dental surgeries authorized. The first two separate operations were made without complications. However, in the third surgical appointment, a high difference in blood pressure was detected between the left and right arms. In this way, the surgery was cancelled and the patient urgently referred to the physician. The medical report demonstrated low blood pressure at the left arm caused by the subclavian steal syndrome with risk of vascular accident and cardiac morbidity. An angioplasty was made and a stent was placed, in addition to antihypertensive medications. A platelet anticoagulant was introduced. The patient was released for dental procedures under guidance of the cardiologist and the vascular surgeon. It can be concluded that routine check of blood pressure in both arms can better screen the patient's physical condition and to improve necessary referrals for the patient's safety.


Subject(s)
Humans , Female , Aged , Arterial Pressure , Dental Implants , Hypertension/drug therapy , Medical History Taking , Subclavian Artery , Subclavian Steal Syndrome
5.
ABC., imagem cardiovasc ; 29(2): 58-62, abr.-jun. 2016. ilus, graf
Article in Portuguese | LILACS | ID: lil-786647

ABSTRACT

A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do troncobraquiocefálico. É uma doença relativamente rara, relatadaem aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análiseda artéria vertebral, registrando informações capazes de identificar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da artéria vertebralavaliadas pelo estudo com Doppler espectral, pode ser classificada nos tipos 1 (oculto), 2 (intermitente ou parcial)e 3 (completo). Com o advento da angioplastia transluminal percutânea e, em seguida, dos stents, muitos advogam essa combinação de procedimentos como o tratamento de escolha dos casos sintomático dessa síndrome.


Subject(s)
Humans , Vertebral Artery/physiopathology , Subclavian Steal Syndrome/therapy , Ultrasonography, Doppler, Pulsed/methods , Angiography/methods , Risk Factors , Stents
6.
Ann Card Anaesth ; 2015 Apr; 18(2): 242-245
Article in English | IMSEAR | ID: sea-158184

ABSTRACT

We are presenting the case of a 76‑year‑old female scheduled for major abdominal surgery. Her past medical history was remarkable for a three‑vessel coronary artery disease, with a severely impaired left ventricular function. She had already undergone complex coronary artery bypass surgery. Currently, she presented with the rare constellation of a hemodynamic relevant and interventionally intractable stenosis of the left subclavian artery proximal to a crucial coronary bypass from left internal mammary artery to the left anterior descending. To protect this patient from perioperative myocardial infarction, an intra‑aortic balloon pump was successfully used.


Subject(s)
Abdomen/surgery , Aged , Coronary Artery Bypass , Coronary-Subclavian Steal Syndrome/surgery , Female , Humans , Intra-Aortic Balloon Pumping/methods , Subclavian Artery/surgery , Subclavian Steal Syndrome/surgery
7.
Article in English | WPRIM | ID: wpr-95471

ABSTRACT

Right aortic arch with isolation of the left subclavian artery is a rare anomaly. The incidence of bilateral ductus arteriosus is sporadic, and a right aortic arch with isolation of the left subclavian artery in association with bilateral ductus arteriosus is therefore extremely rare. Since the symptoms and signs of isolation of the left subclavian artery can include the absence or underdevelopment of the left arm, subclavian steal syndrome, or pulmonary artery steal syndrome, the proper therapeutic approach is controversial. We report a case in which surgical reconstruction was used to treat isolation of the left subclavian artery with right aortic arch in association with bilateral ductus arteriosus and a ventricular septal defect.


Subject(s)
Aorta, Thoracic , Arm , Ductus Arteriosus , Embryology , Heart Defects, Congenital , Heart Septal Defects, Ventricular , Incidence , Pulmonary Artery , Subclavian Artery , Subclavian Steal Syndrome
8.
Article in English | WPRIM | ID: wpr-95432

ABSTRACT

Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.


Subject(s)
Arm , Brachial Artery , Carotid Artery, Internal , Catheters , Constriction, Pathologic , Coronary Artery Bypass , Endovascular Procedures , Femoral Artery , Humans , Mammary Arteries , Middle Aged , Stents , Subclavian Artery , Subclavian Steal Syndrome , Transplants , Vertebral Artery
9.
Rev. cuba. med. mil ; 43(2): 269-273, abr.-jun. 2014. Ilus
Article in Spanish | LILACS, CUMED | ID: lil-722988

ABSTRACT

Paciente femenina de 46 años de edad, con antecedentes de hipertensión arterial y fumadora habitual. Desde hace 2 años presenta episodios aislados y breves de vértigos, inestabilidad postural, sensación de desfallecimiento sin alteraciones de la conciencia, después de realizar ejercicios del brazo izquierdo. El examen neurológico muestra asimetría de pulsos carotídeos y radiales. El doppler extracraneal reveló alteraciones ateroscleróticas en ambos ejes carotídeos, con estenosis derecha del 50 %, disminución del flujo de la arteria vertebral izquierda y obstrucción proximal de la arteria subclavia izquierda proximalmente. El síndrome del robo de la subclavia es una entidad poco frecuente, su diagnóstico es clínico y se demuestra mediante doppler o angiografía. El tratamiento debe ser decidido individualmente en cada caso.


A 46 year-old female patient with a history of hypertension and regular smoker complained of isolated and brief episodes of dizziness, postural instability, faint feeling without altered consciousness, after exercise the left arm for 2 years. Her neurological examination showed asymmetry of carotid and radial pulses. Her extracranial doppler revealed carotid atherosclerotic changes in both axes, with 50 % right stenosis, decreased flow of the proximal left vertebral artery and obstruction of the proximal left subclavian artery. Subclavian Steal Syndrome is a rare condition. Its diagnosis is clinical and it is demonstrated by Doppler or angiography. Treatment should be determined individually in each case.


Subject(s)
Middle Aged , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Vertebral Artery/injuries , Ultrasonography, Doppler, Transcranial/methods , Hypertension/diagnosis
10.
Article in English | WPRIM | ID: wpr-65821

ABSTRACT

Myocardial revascularization using the left internal thoracic artery (LITA) has become a standard method for coronary artery bypass graft (CABG) surgery due to its long-term graft patency and lower repeated revascularization rate compared to a saphenous vein graft. The prevalence of significant subclavian artery stenosis was reported to be 0.2-6.8% in patients undergoing CABG surgery using LITA. We present a case of 49-year-old female patient who complained of resting chest pain and left arm pain after CABG surgery using the LITA. NSTEMI was caused by de novo subtotal left subclavian artery stenosis proximal to the LITA. The left subclavian artery was successfully stented, and the patient experienced complete relief of pain.


Subject(s)
Arm , Chest Pain , Coronary Artery Bypass , Female , Humans , Mammary Arteries , Middle Aged , Myocardial Infarction , Myocardial Revascularization , Perfusion , Prevalence , Saphenous Vein , Stents , Subclavian Artery , Subclavian Steal Syndrome , Transplants
12.
Rev. bras. ecocardiogr. imagem cardiovasc ; 26(1): 61-64, jan.-mar.2013. ilus
Article in Portuguese | LILACS | ID: lil-663444

ABSTRACT

Paciente de 50 anos, sem fatores de risco e/ou desencadeantes conhecidos, apresentou dissecção aórtica tipo A de Stanford. Foi submetido à excisão da valva aórtica nativa, implante de prótese mecânica e reconstrução da raiz da aorta com enxerto orgânico. Três meses após cirurgia, estando totalmente assintomático, foi submetido, em nosso serviço, à ecografia vascular, com Doppler colorido, das carótidas e vertebrais que mostrou fluxo em artéria vertebral direita com padrão de desaceleração mediossistólica (roubo oculto da subclávia direita), também chamado Sinal do Coelho. A angiotomografia mostrou tronco braquiocefálico com lâmina de dissecção em toda a sua extensão, artéria subclávia direita com lâmina de dissecção em seu terço proximal, artéria carótida comum direita com lâmina de dissecção visualizada em seu terço proximal, artéria vertebral direita com origem na artéria subclávia direita (na sua porção sem dissecção). Em face do estado clínico do paciente, foi adotada observação clínica, com acompanhamento angiotomográfico e ecográfico dos vasos cervicais, semestralmente.


A 50-year old patient with an aortic dissection (Stanford type A) with no previous risk factors. Excision of the native valve and implantation of mechanical aortic prosthesis were made. Also, carried out reconstruction of the aortic root with organic graft. Postoperatively, the patient came to our department after three months totally asymptomatic and the color Doppler of carotid and vertebral arteries showed a right vertebral artery flow pattern with mid-systolic deceleration (partial subclavian steal) – bunny rabbit sign. The angiotomography showed brachiocephalic trunk dissection with progression to the proximal third of the right subclavian and common carotid arteries. The right vertebral artery had its origin from the right subclavian artery (in its portion without dissection). Considering the patient’s clinical status, conservative clinical approach was adopted, with angiotomography and ultrasound of cervical vessels every six months.


Subject(s)
Humans , Male , Middle Aged , Subclavian Steal Syndrome/complications , Brachiocephalic Trunk/abnormalities , Aortic Valve/surgery , Electrocardiography/methods
14.
Article in English | WPRIM | ID: wpr-44592

ABSTRACT

We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.


Subject(s)
Angioplasty , Arterial Occlusive Diseases/complications , Erectile Dysfunction/etiology , Humans , Iliac Artery/pathology , Intermittent Claudication/complications , Male , Middle Aged , Stents , Subclavian Steal Syndrome/complications
15.
Rev. bras. ecocardiogr. imagem cardiovasc ; 25(4): 298-301, out.-dez. 2012. ilus
Article in Portuguese | LILACS | ID: lil-653988

ABSTRACT

A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do tronco braquiocefálico. É uma doença relativamente rara, relatada em aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análise da artéria vertebral, registrando informações capazes de identicar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da arteria vertebral avaliadas pelo estudo com Doppler Espectral, podem ser identificados três tipos de roubo da subclávia: oculto, parcial e completo. Com o advento da angioplastia transluminal percutânea e, em seguida, dos Stents, muitos advogam esta combinação de procedimentos como o tratamento de escolha dos casos sintomático desta síndrome.


Subject(s)
Humans , Angioplasty/methods , Angioplasty , Vertebral Artery/abnormalities , Echocardiography, Doppler, Pulsed/methods , Echocardiography, Doppler, Pulsed , Subclavian Steal Syndrome/complications , Tobacco Use Disorder
16.
Article in English | WPRIM | ID: wpr-14866

ABSTRACT

Isolated left brachiocephalic artery with right aortic arch is extremely rare congenital anormaly. This malformation can cause subclavian steal phenomenon. We report the duplex sonographic and conventional angiographic findings of isolated left brachiocephalic artery in a 22-year-old female presented with dizziness.


Subject(s)
Aorta, Thoracic , Arteries , Dizziness , Female , Humans , Subclavian Steal Syndrome , Young Adult
17.
Article in English | WPRIM | ID: wpr-126046

ABSTRACT

The proximity of thoracic aortic aneurysm to the left subclavian artery (LSA) has made the coverage of LSA during thoracic endovascular aortic repair (TEVAR) be essential. Despite controversy concerning the safety of LSA coverage and the indications for LSA revascularizations, the cerebral hemodynamic change after LSA coverage has not been demonstrated. We prospectively examined two patients who would undergo TEVAR with LSA coverage by using 2D cine phase contrast MR imaging. After LSA coverage, the left subclavian steal was properly compensated by the increased flow volumes of both carotid arteries and right vertebral artery, which is the major collateral supply. The total brain supply after TEVAR did not lessen, which showed good correlation with uneventful clinical outcome. Therefore, 2D phase contrast MR imaging can be recommended as a useful technique to evaluate the hemodynamic change of the LSA coverage during TEVAR and to triage the candidate for LSA revascularization.


Subject(s)
Aortic Aneurysm , Aortic Aneurysm, Thoracic , Brain , Carotid Arteries , Hemodynamics , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Magnetics , Magnets , Prospective Studies , Subclavian Artery , Subclavian Steal Syndrome , Triage , Vertebral Artery
18.
Rev. chil. neurocir ; 36: 78-84, jun. 2011. ilus
Article in Spanish | LILACS | ID: lil-665178

ABSTRACT

It is the obstruction or estenosis of an artery’s proximal segment, which is close to the origin the vertebral artery. This causes blood flow inversion within the ipsilateral artery. An increase in the irrigation demands of the artery may cause TIA in the posterior circulation, which is denominated as subclavian steal syndrome. In these cases, contralateral circulation may contribute to prevention of several events due to hypoperfusion. In the case in which a subclavian estenosis accompanied by alteration in blood flow in the contralateral artery arises, symptoms corresponding to the irrigation area affected will be generated.


Se denomina de esta manera a la obstrucción o estenosis del segmento proximal de dicha arteria, cercano al origen de la arteria vertebral, lo que provoca inversión del flujo de la arteria vertebral ipsilateral. Un incremento en la demanda de la irrigación de la arteria vertebral puede provocar un AIT en la circulación posterior, o “robo de la subclavia”. De acontecer esto, existe el aporte de la circulación contra lateral que puede prevenir los diversos eventos debido a la hipoperfusión. De coexistir una estenosis de la subclavia con alteraciones de la circulación contralateral, se generaran los síntomas respectivos al área de irrigación afectada.


Subject(s)
Humans , Male , Adult , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/therapy , Subclavian Artery , Vertebral Artery
20.
Rev. méd. hondur ; 79(1): 22-24, ene.-mar. 2011. ilus
Article in Spanish | LILACS | ID: lil-644943

ABSTRACT

Introducción. El síndrome de robo de la subclavia es una entidad rara que predomina en hombres, asociada a ateroesclerosis en mayores de 50 años y a patologías como la enfermedad de Takayasu en pacientes menores de 30 años. Su detección temprana para manejo quirúrgico es clave. Caso clínico: Evaluamos paciente masculino de 64 años de edad con historia de parestesias del miembro superior izquierdo y vértigo de cuatro meses de evolución, asociado a cambios en la presión arterial de ambos miembros superiores y pulsos disminuidos.Se solicitó estudio de angiotomografía de tórax, que evidenció trombosis por ateromatosis del tercio proximal de la arteria subclavia izquierda con circulación post estenosis por la arteria vertebral ipsilateral. El Doppler color reveló flujo retrógrado y turbulento con ausencia del pico diastólico final. Conclusión. Los hallazgos correspondieron a un síndrome de robo de la subclavia. El paciente fue referido para procedimiento quirúrgico.


Subject(s)
Humans , Male , Middle Aged , Subclavian Artery/abnormalities , Atherosclerosis/diagnosis , Subclavian Steal Syndrome/diagnosis , Angiography/methods , Ultrasonics
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