Surgical treatment of the subclavian steal syndrome

Cerebrovascular insufficiency produced as a result of reversal of the flow in the vertebral artery secondary to occlusion in the proximal subclavian or innominate arteries is now termed the subclavian steal syndrome. Symptoms are primarily those of basilar artery insufficiency but forebrain ischemic symptoms also occur. The diagnosis is suspected when a difference in the blood pressure and pulse between the right and left arm is detected and it is confirmed by contrast arteriography demonstrating retrograde flow in the vertebral artery. Treatment is surgical relief of the arterial obstruction or stenosis in those patients with radiographically demonstrated subclavian steal syndrome. Two patients treated surgically are presented. One patient had occlusion of the right subclavian artery treated by thromboendarterectomy and patch graft through a transverse neck incision with resection of the clavicle. The other was treated in a similar fashion through a left posterolateral thoracotomy incision. Surgical therapy is effective.