Subclavian Steal Syndrome - case study. Diagnostic, therapeutic, and instrumental approaches

Abstract

Subclavian Steal Syndrome (SSS) is a vascular disorder characterized by occlusion or stenosis of the proximal sub- clavian artery, resulting in a compensatory retrograde blood flow through the ipsilateral vertebral artery. This altered hemodynamic state may lead to a variety of clinical manifestations, including neurological deficits, cardiovascular symp- toms, and ischemia of the affected upper limb. Furthermore, SSS is recognized as a potential cause of syncope or presyn- copal episodes due to cerebral hypoperfusion, particularly triggered by positional changes of the arm.The etiology of SSS is most frequently linked to atherosclerotic disease, though it may also result from congenital arteriovenous malformations or iatrogenic causes, such as postoperative complications following coronary artery bypass grafting (CABG), especially when the internal mammary artery is utilized as a conduit. The defining feature of SSS lies in the reversal of blood flow and the disruption of normal circulatory dynamics. This hemodynamic compromise can have significant cardiovascular implications, highlighting the importance of vigilant monitoring in patients with a history of coronary artery surgical interventions. Accurate assessment of postoperative blood flow is essential to prevent serious complications, including myocardial ischemia. Additionally, routine measurement of blood pressure in both arms in ambulatory settings should be emphasized, as significant inter-arm blood pressure differences may serve as clinical indicators of underlying vascular pathologies, including SSS, peripheral vascular disease, or other circulatory anomalies