1/5. Subclavian steal syndrome: a rare but important cause of syncope.An elderly woman came to our emergency room for evaluation of a syncopal episode. While climbing a flight of stairs, she had turned her head to the left and abruptly passed out. Positive physical findings included blood pressure of 141/65 mm Hg (right arm) and 80/43 mm Hg (left arm), as well as nonpalpable left radial and brachial pulses that were detectable only by Doppler ultrasonography. Carotid duplex ultrasonography showed reverse flow in the left vertebral artery and an abnormal, stenotic distal left subclavian artery. magnetic resonance angiography confirmed complete occlusion of the left subclavian artery with classic subclavian steal. The patient had percutaneous transluminal angioplasty with stenting of the left subclavian artery and has remained asymptomatic through 2 years of follow-up with aggressive risk-factor modification.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. The significance of subclavian artery injection prior to surgical myocardial revascularization.Successful arterial revascularization using the internal thoracic artery is dependent on unobstructed inflow through the subclavian artery. Systematic physical examination should discover subclavian stenosis; however, simple routine injection into the orifice of the subclavian artery during the diagnostic catheterization may avoid a catastrophic outcome.- - - - - - - - - - ranking = 15.62572156476keywords = physical examination, physical (Clic here for more details about this article) |
3/5. coronary-subclavian steal syndrome presenting with chest pain and syncope.The present case is a 68-year-old patient with complaints of chest pain and syncopal attacks during physical activity of the left arm, for the last six months. He had a coronary artery bypass graft operation 10 years ago. Angiographic examination demonstrated total occlusion of the subclavian artery. The subclavian artery was stealing blood from the left anterior descending artery via the left internal mammary artery and from the brain via the left vertebral artery, leading to the diagnosis of subclavian artery steal syndrome; a rare cause of coronary and cerebral ischaemia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Symptomatic subclavian steal syndrome four decades after operation for dysphagia lusoria.congenital abnormalities of the aortic arch may lead to signs and symptoms of tracheal and esophageal obstruction secondary to a restrictive vascular ring. There are many case reports and monographs concerning the surgical management of dysphagia lusoria. This case provides the first example of long-term follow-up of surgical intervention for relief of dysphagia lusoria. A 45-year-old laborer presented with a several year history of episodic bilateral blindness and a more recent onset of "drop attacks." Notably this patient had presented at the age of 18 months with difficulty breathing and eating since birth. The patient also had frequent upper respiratory infections and episodes of pneumonia. Workup revealed a right-sided aortic arch with a left ligamentum arteriosum. When he was first seen in our clinic, history and physical examination revealed claudication and diminished pulses in the left upper extremity. Arteriography and duplex studies confirmed reversal of flow in the patient's left vertebral artery. The arteriogram demonstrated the presence of a right-sided aortic arch and descending aorta along with the proximal stump of the previously ligated left subclavian artery. He underwent left carotid to left axillary artery bypass for the treatment of symptomatic subclavian steal syndrome. His symptoms have resolved with return of antegrade vertebral flow and the presence of normal pulses in the left arm. Congenital aortic abnormalities that lead to tracheal and esophageal compromise are numerous and varied. Surgical management requires a thorough understanding of the person's anatomy and preoperative planning. The life expectancy of patients with dysphagia lusoria necessitates consideration of the long-term consequences of surgical intervention.- - - - - - - - - - ranking = 15.62572156476keywords = physical examination, physical (Clic here for more details about this article) |
5/5. Bilateral subclavian steal syndrome.Two cases of bilateral subclavian steal syndrome are presented, demonstrating complete occlusion at the origin of both subclavian arteries with distal reconstitution via reversal of blood flow through the vertebrobasilar system. Since unsuspected subclavian artery obstruction may present significant angiographic hazard, careful physical examination including blood pressures in both upper extremities and auscultation of the neck is necessary in order to avoid undesirable complications.- - - - - - - - - - ranking = 15.62572156476keywords = physical examination, physical (Clic here for more details about this article) |