Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The subclavian steal syndrome (SSS) is often associated with occlusive disease involving the subclavian or innominate arteries, but an asymptomatic subclavian steal, called the "subclavian steal phenomenon" (SSP), is not uncommon. Though intracranial collaterals had been postulated as one of the etiologies for the SSP's being asymptomatic, little has been accomplished in the investigation of extracranial channels. To study the hemodynamic role of cervical collateral channels, an angiographical study was done in three cases with SSP. The three cases were admitted to the hospital because of carotid ischemic symptoms, such as right hemiplegia or sensory aphasia. Each case had a blood pressure difference between the two arms, but in all of them the past history or the exercise test was negative for vertebrobasilar or arm ischemia. On angiography, occlusions of the unilateral proximal subclavian artery, the left in case 1 and the right in case 2, or a tight stenosis of the innominate artery was found in case 3. In each case, the vertebral artery flow in the affected side was inverted, siphoning off from the opposite vertebral artery into the affected subclavian artery. In addition to the vertebral siphoning; muscular branches of ipsilateral external carotid origin in cases 1 and 2, or the thyrocervical trunk via the inferior thyroid artery in case 3 was also found to function as a collateral channel to the vertebral artery on the affected side.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The significance of cervical collaterals in the subclavian steal phenomenon]. 829 73

Arterial occlusive disease of the upper extremity is most often due to posttraumatic occlusion of the ulnar artery. An embolic source of the ischemia should be considered most strongly when sudden ischemia or vasospasm is associated with atrial fibrillation or follows a myocardial infarction. Connective tissue disorders and several arteridities are infrequent causes of upper-extremity occlusive disease and can usually be detected by a thorough peripheral vascular examination and blood studies. Atherosclerosis of the upper extremity is usually localized to the region of the subclavian artery and can present as a subclavian steal syndrome or arm ischemia. Finally, upper-extremity venous occlusive disease occurs in association with the hypercoagulable state, venous endothelial injury, or arises in otherwise healthy patients because of venous impingement in the thoracic outlet.
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PMID:Occlusive vascular disorders of the upper extremity. 844 72

The incidence of subclavian steal syndrome is poorly documented in recent literature; however, there is general agreement that it is a relatively uncommon diagnosis. The actual occurrence of a subclavian steal is more common than the associated syndrome. Symptoms of arm ischemia and vertebral-basilar insufficiency secondary to a subclavian steal can become quite disabling in some patients. Through astute observation and assessment, nurses may be the first to identify a patient with subclavian steal syndrome. Subclavian steal may be identified by nurses during routine history and physical examination. All patients initially seen with discrepant arm blood pressures or a diminished or weakened radial pulse unilaterally should have the diagnosis of subclavian steal considered during their evaluation. In addition, patients with vertebral-basilar symptoms or arm ischemia should have the diagnosis of subclavian steal ruled out. This article presents a review of the history, pathogenesis, current treatment modalities, and nursing care of patients with a subclavian steal.
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PMID:Subclavian steal syndrome: a review. 870 95

Subclavian artery stenosis is found in up to 25% of patients with supraaortic lesions. Bypass grafting is the recommended procedure of choice but there is still debate concerning the optimal technique. We therefore performed a retrospective analysis to determine the prognostic factors based on long-term results. Between 1974 and 1992, fifty-five patients were treated for subclavian artery stenosis. The methods used were carotid-subclavian artery bypass (KSBP, n = 40) and aorto-subclavian artery bypass (ASBP, n = 15). Indications for surgery included vertebrobasilar insufficiency (20.0%), upper extremity ischemia (20%) and the combination of both (58.2%). Arteriosclerosis was the predominant cause of disease (85.5%). Peri-operative mortality was limited to one patient in the KSBP-group (2.5%). Post-operative morbidity was significantly lower in the KSBP-group (10.0%) as compared to the ASBP-group (40.0%, p = 0.018). Relief of symptoms was achieved in 97.4% of KSBP procedures and in 92.9% of ASBP procedures. Patients were followed up for a mean period of 73.7 +/- 58.0 months. Cumulative 5-year patency rates of 71.4% (ASBP) and 83.3% (KSBP) were not significantly different between both groups (p = 0.089). Pharmacologic therapy with acetylsalicylic acid (ASA) led to a statistically significantly better 5-year patency rate (100%) as compared to the combination of ASA and dipyridamole (71.4%, p = 0.016) or phenprocoumone alone (50.0%, p < 0.001) or no anticoagulation (71.4%, p = 0.005). In our experience carotid-subclavian bypass has an excellent long-term patency rate with a low peri-operative morbidity as compared to transthoracic bypass procedures (ASBP). Therefore KSBP should be the procedure of choice to correct proximal subclavian artery stenosis. Platelet inhibitors will increase bypass patency rate significantly.
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PMID:[Supra-aortic bypasses for revascularization of the subclavian artery: early and late results of extra-thoracic and transthoracic methods: are extra-anatomic conduits superior?]. 896 52

We report the results of stenting in 17 patients who underwent treatment for total occlusions in the subclavian arteries between July 1991 and December 1995. Fourteen of the lesions were located in the left side; 15 patients had a subclavian steal syndrome. The indications for treatment were vertebrobasilar insufficiency (n = 7); arm claudication (n = 5); vertebrobasilar insufficiency and upper-limb ischemia (n = 3); protection of a left internal mammary artery coronary bypass (n = 1); and an isolated subclavian steal syndrome (n = 1). A total of 23 stents were implanted in 17 patients; in 1 patient, 2 stents migrated during deployment, resulting in a 94% procedural success rate. One case of axillary thrombosis was successfully treated with local thrombolysis and balloon angioplasty. There were no postprocedural neurologic complications or deaths. Follow-up over a mean duration of 19.4 months (range, 4 to 56 months) revealed 1 asymptomatic restenosis at 5 months in a patient with 3 stents. Life-table analysis showed an 81% cumulative patency rate at 6 months. We conclude that stenting for occlusion of the subclavian arteries appears feasible and safe; however, further evaluation in a larger group of patients is needed to confirm these results.
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PMID:Stenting for occlusion of the subclavian arteries. Technical aspects and follow-up results. 906 35

Subclavian artery stenosis is found in up to 25% of supraaortic lesions. Bypass grafting is the procedure of choice but controversies exist concerning the optimal technique and the effect of postoperative antithrombotic therapy on long-term patency. The authors retrospectively analyzed 40 patients with carotid-subclavian bypasses. Stenoses were documented preoperatively by arteriography. Patency was determined by clinical, ultrasound, or arteriographic examinations. Cumulative patency rates were calculated by Kaplan-Meier method and analyzed by Tarone-Ware test. Graft materials were Dacron (32), polytetrafluoroethylene (seven) or saphenous vein (one). Indications for surgery included vertebrobasilar insufficiency (22.5%), upper extremity ischemia (22.5%), and the combination of both (55.0%). Perioperative mortality and morbidity were 2.5% and 10.0%, respectively. Patients were followed up from 0 to 134 months (mean 61+/-39 months). Cumulative 5-year patency rate was 83.3%. Anticoagulation with acetylsalicylic acid (ASA) led to significantly better 5-year patency rates (100%) as compared with the combination of ASA and dipyridamole (64.0%, p=0.013) or no anticoagulation (70.0%, p=0.016). Carotid-subclavian bypass led to excellent long-term patency rates and can provide durable relief of symptoms with minimal perioperative morbidity and mortality. Therefore, it is a worthwhile procedure to correct proximal subclavian artery stenosis. Postoperative medication with ASA seems to increase long-term bypass function significantly.
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PMID:Carotid-subclavian bypass for subclavian artery revascularization: long-term follow-up and effect of antiplatelet therapy. 955 31

After coronary bypass surgery in the left internal mammary artery, occlusive atherosclerosis in the proximal subclavian artery can produce reverse flow in the mammary artery and myocardial ischemia (coronary-subclavian steal syndrome). This is a rare cause of recurrent myocardial ischemia. We present two patients with postoperative complete obstruction in the proximal subclavian artery and inverse flow in the mammary artery producing severe ischemia in the left anterior descending artery territory. Both patients were treated with subclavian-subclavian bypass, which in one patient was ineffective in producing an adequate anterograde flow in the left internal mammary artery. We review clinical management, diagnostic methods and therapeutic options used in the coronary-subclavian steal syndrome.
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PMID:[Angina caused by subclavian-coronary steal in patients revascularized with internal mammary artery]. 980 7

We present a case of 'subclavian steal syndrome' secondary to Takayasu arteritis, in a 32-year-old, Japanese woman, whose clinical manifestations result from severe ocular and brain ischemia, refractory to high dose systemic corticosteroids. Surgical management using two bypass-grafts was carried out. The first one, a GoreTex, 8 mm in diameter, thin wall, stretch type with ring-bypass graft, from the left external iliac artery to the ipsilateral axillary artery. The second one, an autologous reverse saphenous vein graft from the left subclavian artery to the ipsilateral common carotid artery. The result was a remarkable improvement of the patient's general condition and symptoms. Patency of the extra-anatomic conduits was established by digital subtraction angiography (DSA), and transcranial Doppler evaluation, as well as flow velocity assessment revealed an objective improvement of the blood supply to the ischemic areas. The present surgical approach was justified since the inflammatory process extended to the aortic arch. The development of new and efficient operatory techniques, and continuous improvement of the graft-materials provide better expectations for the long-term outcome of refractory syndromes.
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PMID:Subclavian steal syndrome secondary to Takayasu arteritis. 995 24

Proximal subclavian or brachiocephalic artery obstruction may present with a variety of symptoms. Surgery has been considered by many to be the corrective procedure of choice, but percutaneous alternatives are becoming increasingly popular. Little work has been done to compare the outcomes of the two techniques. Presenting symptoms in this condition often include angina secondary to coronary-subclavian steal, subclavian steal syndrome, arm ischemia, and axillo-femoral graft inflow obstruction. A systematic review of the surgical literature has been performed and has included analysis of the incidence of technical success, overall complications, stroke, death, and subsequent patency. However, despite comparison of these data to the published series of stenting, there are no head-to-head trials of one technique versus another. Review and analysis of the contemporary literature suggests a high patency and low complications in stent series, and is in contrast to similar midterm patency but a higher incidence of stroke and death in the surgical literature. A variety of techniques can be used for successful stent-based revascularization, and a blending of skills from the traditional "coronary" and "peripheral" venues may be helpful. Comparison with the published surgical experience suggests that the effectiveness of percutaneous revascularization is at least equivalent and that these techniques may be associated with fewer procedure-related serious complications. Percutaneous stenting should be considered a first-line therapy in treating subclavian or brachiocephalic obstruction.
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PMID:Subclavian and Innominate Revascularization: Surgical Therapy Versus Catheter-Based Intervention. 1109 57

The coronary-subclavian steal syndrome is a rare cause of recurrent myocardial ischemia in patients who have undergone left internal mammary-coronary artery bypass grafting. A significant left subclavian artery stenosis proximal to its origin, can result in an impaired or reversed flow in this graft and myocardial ischemia. We describe the case of a woman aged 76 who had undergone myocardial revascularization seven months before, and presented refractory angina with severe electrocardiographic ischemia in the left anterior descending artery territory. Arteriography confirmed this syndrome and the patient was successfully treated with percutaneous transluminal angioplasty and placement of two stents in the left subclavian artery. We review the clinical management, diagnostic methods and therapeutic options used in the subclavian-coronary steal syndrome.
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PMID:[Refractory angina caused by subclavian-coronary steal syndrome treated with angioplasty and stent]. 1144 71


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