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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare occurrence of carotid subclavian steal syndrome following carotid subclavian bypass for arm ischemia was described. Blood flows in the carotid artery and carotid subclavian bypass, at rest and following arm exercise, were determined by video dilution technique during the angiographic procedure. There was no obstruction of the inflow or outflow of the proximal or distal anastomoses to account for the steal (55%). Rather, increased arterial flow to the subclavian artery due to the patient's status as a bilateral amputee was thought to be the cause. The diagnosis and subsequent correction by takedown of this bypass and conversion to an axillary-to-axillary bypass were performed. Video dilution technique offers a unique and accurate way to study steal phenomena in conjunction with routine angiography and does not add to the patient's cost or risk.
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PMID:Surgically induced carotid subclavian steal syndrome. Diagnosis by video dilution technique. 635 49

A 70-year-old man manifested during four years a progressive clinical picture consisting in palsy of gaze, axial rigidity, disorders of standing and gait, dysarthria, dysphagia. Neuroradiological investigations demonstrated proximal thrombosis of the left subclavian artery with subclavian steal. At necropsy, degenerative changes in several areas of the basal ganglia and brain stem, with presence of globose neurofibrillary tangles, were found, consistently with the pathologic pattern of the Progressive Supranuclear Palsy (PSP). The association of PSP and subclavian steal syndrome has not been previously reported, to our knowledge. We hypothesize that chronic ischemia, due to subclavian steal syndrome, in the vertebral basilar system and its watershed versus carotid system may have favoured the appearance, in these same areas, of the changes of the PSP.
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PMID:Progressive supranuclear palsy in the course of subclavian steal syndrome. 693 74

Thirty-eight patients underwent operations for subclavian artery stenosis over a 12-year period. Nineteen patients had neurologic symptoms and 12 had claudication or ischemia. The classic subclavian steal syndrome was rare. Twenty patients underwent carotid subclavian bypass and 14 underwent subclavian endarterectomy using a cervical or thoracic approach. Follow-up data were available in 35 of 38 patients (average follow-up 36 months). Thirteen of the 14 patients who underwent endarterectomy remained asymptomatic and showed no evidence of restenosis (average follow-up 53 months). Of the 20 patients who had carotid subclavian bypass, Dacron was the graft material used in eight patients and autogenous saphenous vein was used in 12. Thrombosis occurred in five of 12 saphenous vein grafts, two immediately after operation, one at 2 months and two at 10 months. An anastomotic stenosis was identified and corrected in one patient 38 months postoperatively. Recurrent or persistence of symptoms was directly related to graft failure. Thrombosis or stenosis did not occur in any of the Dacron grafts. All patients had some relief of symptoms. Subclavian endarterectomy or carotid subclavian bypass with Dacron gave excellent long-term results. Autogenous saphenous vein were unsatisfactory for these short bypasses.
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PMID:Surgical treatment of occlusive subclavian artery disease. 724 27

Occlusive disease of the aortic arch vessels is relatively rare and often missed initially. Of 41 patients treated surgically for this condition over a 10-year period 38 had arteriosclerotic lesions, 2 had symptoms secondary to vasculitis (Takayasu's arteritis) and 1 had a radiation injury to a subclavian artery. In 22 cases the left subclavian artery was involved; the right subclavian and innominate arteries were the next most commonly affected. Only four vertebral stenoses were treated. Most patients presented with a combination of arm and hindbrain ischemia that was shown radiologically to be associated with a subclavian steal syndrome, but in some only isolated arm symptoms or severe vertigo alone was experienced. There was a difference in blood pressure between the arms of at least 20 mm Hg in 88% of the patients. The treatment for 28 patients was creation of a carotid-subclavian bypass, for 6 the placement of a bypass graft from the ascending aorta to the subclavian or carotid artery or both, for a 3 a subclavian endarterectomy and for 4 vertebral angioplasty. There were no operative deaths, and 90% of the grafts were patent 1 to 72 months later. however, only 30 (73%) of the patients were asymptomatic and 9 (22%) had improved.
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PMID:Surgical management of chronic occlusive disease of the aortic arch vessels and vertebral arteries. 726 Jul 99

Combining a subclavian flap procedure and reimplantation of the distal subclavian artery into the left carotid artery was used in 2 patients with recurrent coarctation of the thoracic aorta. One of the patients was 12 years old and the other, 6 years old. The operation has several advantages. (1) It is very efficient in relieving recurrent gradients. (2) The use of prosthetic material is avoided. (3) Minimal dissection is required. (4) It prevents subsequent subclavian steal syndrome and long-term ischemia of the left upper limb.
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PMID:Recurrent coarctation of the thoracic aorta: subclavian flap arterioplasty with carotid reimplantation of the distal subclavian artery. 730 33

The internal mammary artery (IMA) is the conduit of choice for cardiac revascularization. The phenomenon of retrograde flow in this graft secondary to proximal subclavian artery stenosis is an infrequent but increasingly recognized clinical entity and has been termed the "coronary-subclavian steal syndrome." We report on five patients with this syndrome. All were men. The average age was 65 years (range 56 to 68 years). The mean interval from coronary bypass to presentation was 7.8 years (range 1 month to 18 years). Three patients presented with unstable angina and one with congestive heart failure. One patient was asymptomatic from a cardiac standpoint. The mean arm systolic blood pressure differential was 45 mm Hg (range 30 to 60 mm Hg). Each patient underwent cardiac catheterization, and retrograde IMA flow was demonstrated in 100%. Arteriography confirmed the presence of a proximal high-grade (> 75%) subclavian stenosis in all patients. Stress thallium scanning was performed in two patients and demonstrated anterolateral ischemia in both. Operative intervention in four patients consisted of a left carotid-subclavian bypass using an 8 mm synthetic graft. There was no perioperative morbidity or mortality. Postoperative thallium scanning revealed resolution of the ischemic process. The average length of follow-up was 20 months (range 12 to 25 months) with all patients remaining asymptomatic. The one patient who refused surgery died at 12 months. When IMA grafting is contemplated, proximal subclavian stenosis should be suspected if there is > 20 mm Hg systolic pressure differential between the arms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Coronary-subclavian steal syndrome: report of five cases. 770 55

A 75-year-old man who had a small right parietal infarction 8 months earlier underwent baseline and acetazolamide enhanced Tc-99m hexamethylpropylene amineoxime brain SPECT imaging. The acetazolamide study demonstrated a bilaterally symmetric perfusion deficit posteriorly near the midline. The baseline study was essentially normal. This finding was felt to represent watershed ischemia at the junction of the anterior circulations (anterior cerebral and middle cerebral arteries) and the posterior circulation (posterior cerebral artery). Carotid arteriography subsequently demonstrated left subclavian steal syndrome with retrograde flow through the left vertebral artery.
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PMID:Watershed ischemia demonstrated with acetazolamide enhanced Tc-99m HMPAO SPECT. 774 55

From 1982 to 1992, 25 patients with subclavian steal syndrome (SSS) were admitted with 20 undergoing surgery. Etiology included atherosclerosis 56% (14/25), Takayasu's disease 36% (9/25), 14 of them were smokers. Stenosis or occlusion of the left subclavian artery were found in 14, the right in 7, and bilateral in 4. 14 cases had vertigo symptoms, 24 cases had claudication of the arm, 9 of them complained transient ischemic attack (TIA). Carotid to subclavian bypass were performed for 15 cases. Two patients underwent axilloaxillary bypass with evidence of both clinical and laboratory improvement. Aorta-Carotid graft bypass was done in 2 cases with good result in one. PTA was done for a girl with innominate severe stenosis but symptom recurred three months later. Symptoms of the upper extremity ischemia were relieved in 75% of the patients, and of the cerebrovascular ischemia in 50%. Our conclusion is that surgical therapy remains the treatment of choice in symptomatic patients.
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PMID:[Subclavian steal syndrome: a report of 25 cases]. 784 5

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for subclavian artery (SCA) stenosis before or after coronary artery bypass grafting (CABG) with the internal mammary artery (IMA). There were 8 men and 3 women with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of asymptomatic subclavian murmurs or of neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was present on the left side in 9 patients, the right side in one patient, and was bilateral in one patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. Three complications occurred: 1 femoral artery thrombosis, 1 branchial plexus hematoma after an axillary approach, and 1 acute pulmonary edema after the procedure. Follow-up ranged from 1 to 60 months after PTA (mean 38 +/- 17 months). Nine patients had no angina at follow-up and 2 presented with stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in all of these patients, at a mean follow-up of 38 months. Subclavian artery percutaneous transluminal angioplasty is a useful alternative for candidates to IMA bypass grafting with SCA stenosis discovered pre-operatively, and it is the treatment of choice for those presenting with post-CABG angina due to SCA stenosis proximal to an IMA graft.
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PMID:[Results of percutaneous dilatation of subclavian artery stenosis in patients with internal mammary grafts]. 790 85

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for the treatment of subclavian artery stenosis before or after coronary artery bypass grafting (CABG) using the internal mammary artery (IMA). There were 8 men and 3 women, with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of either asymptomatic supraclavicular murmurs or neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was on the left side in 9 patients, the right side in 1 patient, and bilateral in 1 patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. There were three complications: one femoral artery thrombosis, one brachial plexus hematoma after an axillary approach, and one acute pulmonary edema after the procedure. Follow-up after PTA ranged from 1 to 60 months (mean, 38 +/- 17 months). Nine patients had no angina at follow-up and 2 had stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in any of these patients at a mean follow-up of 38 months. Subclavian artery PTA is a useful alternative to IMA bypass grafting in patients with subclavian artery stenosis discovered preoperatively, and it is the treatment of choice for those presenting with post-CABG angina due to subclavian artery stenosis proximal to an IMA graft.
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PMID:Transluminal angioplasty of the subclavian artery in patients with internal mammary grafts. 810 60


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