Do you sometimes feel dizzy or have blurred vision? Or do you feel like your arm is going numb or numb, especially when you do something with your hands, lift something heavy, or turn your head to one side suddenly? If this happens, it could be a condition we're talking about today called "Subclavian Steal Syndrome." The name may sound a little strange, like, "Is this a steal disease?" Don't worry, let's talk about it simply and clearly.
What exactly is Subclavian Steal Syndrome?
Simply put, subclavian steal syndrome is when some of the blood that should be going to your brain "steals" into your arm. This happens because the subclavian artery, a major blood vessel that supplies blood to your arm (usually the one on the left side), is either blocked or constricted.
Think of it this way. You're trying to eat a plate of food. It's like someone right next to you "sneaking" a bite or two of the food you're trying to eat. Some of the nourishing blood that should be going to your brain "sneaks" into your hand. So the amount of blood that could be going to your brain decreases, just like the amount of food you could be eating decreases.
As this artery becomes more and more blocked, blood flows through the subclavian artery at a lower pressure. However, the blood pressure in the other arteries nearby is higher. As a result, the blood flow in the vertebral artery, which branches off the subclavian artery and carries blood to the brain, reverses. Then some of that blood gets into the subclavian artery and goes to the arm. That's what's called a "steal."
There is another condition called "coronary steal syndrome". This is when the blood that should go to the heart muscle is blocked. This does not happen to everyone, but only to some people who have had certain types of heart surgery (coronary artery bypass surgery). The main cause of both of these syndromes is the buildup of fat in the artery walls, or "plaque", a condition called "atherosclerosis" in medical terms. Or there may be other reasons that cause the subclavian artery to narrow.
How common is this condition?
Researchers can't say exactly how many people have subclavian steal syndrome, but they estimate that between 0.6% and 6.4% of the population may have it. In addition, about 18% of people with peripheral artery disease also have the syndrome.
This condition is most common in men and people over the age of 55 .
However, thanks to advanced imaging techniques available today, this condition has become more detectable even in people without symptoms.
What are the symptoms of subclavian steel syndrome?
Symptoms of subclavian steel syndrome often occur when you are doing manual labor or suddenly turning your head to one side. See if you have any of these symptoms:
- Blurry vision
- Dizziness
- Pain, numbness, tingling, or a feeling of heaviness in the hand
- Fainting
- Hearing loss (rare)
- Feeling like you are spinning around (Vertigo)
- Ataxia is a condition in which the body loses its balance and cannot walk properly.
But most people don't experience any symptoms. That's because their brains get enough blood from other healthy arteries. They don't need treatment.
What causes subclavian steel syndrome?
There are a few main reasons for this:
- Atherosclerosis - This is the most common cause.
- Arteriovenous malformations (abnormal connections between arteries and veins)
- Aortic dissection
- Takayasu's arteritis, an inflammatory condition of the arteries
- Fibromuscular dysplasia is an abnormal growth of the artery walls.
These causes are similar to those that cause subclavian artery stenosis.
Who is most at risk for this?
Here are some factors that increase the risk of developing subclavian steel syndrome:
- If you have had surgery to correct a narrowing of the aorta (coarctation of the aorta).
- If there are any problems with the aortic arch or some of the blood vessels from birth.
- Compression of the subclavian artery (this is common in some athletes).
- If there is an extra rib (cervical rib) in the neck area.
What complications can arise from this condition?
If you have fainting spells due to subclavian steal syndrome, it can lead to falls and injuries. It can also make it difficult to do any work with the affected arm.
How is subclavian steel syndrome diagnosed?
The first thing a doctor does to diagnose this is to do a physical exam. The doctor will pay special attention to the pulse in your hands and wrists. He will also check the carotid arteries on both sides of your neck and the subclavian artery, looking for any unusual "swoosh..." sounds (bruit). If you hear such a sound with the stethoscope, there may be a blockage in that artery.
What are the symptoms of "Steele Syndrome" seen during a medical examination?
If you have subclavian artery syndrome, your doctor will measure your blood pressure in both arms and see a difference in the readings. The blood pressure in one arm may be as much as 15 millimeters of mercury (mmHg) higher than the other.
Also, if the radial pulses are checked at the same time, the pulse on the side with subclavian steel syndrome may appear weak and may feel like a thud.
What tests are done to confirm this?
The doctor will first perform an ultrasound of your subclavian artery. After that, the following tests may also be performed, as needed:
- MRA (magnetic resonance angiogram) test.
- CT Angiogram (CT - computed tomography angiogram) test.
- Digital subtraction angiogram - This is a special method that removes other body parts from the image and only the blood vessels can be clearly seen.
These tests allow doctors to classify the severity of subclavian steel syndrome (mild or severe). They use grades I, II, and III, with Grade III being the most severe. They also help determine what type of treatment is needed.
What are the treatments for subclavian steel syndrome?
If you have symptoms, you may need to have surgery to improve blood flow in the subclavian artery as a treatment for subclavian artery stenosis. Depending on your condition, this may be an open surgery or an endovascular surgery (a procedure that involves inserting small instruments through a blood vessel). You should avoid excessive use of the affected arm until the surgery is done.
If you are not suitable for surgery, your doctor may prescribe anticoagulants or antiplatelets.
If you have mild symptoms, they may improve over time. In such cases, your doctor may prescribe medication to lower your blood pressure and cholesterol levels.
The important thing is that people who are asymptomatic usually do not need treatment. However, if you have narrowing in your subclavian artery, there is a high chance that it will be the same in other arteries. This is because this type of plaque buildup (atherosclerosis) usually affects arteries throughout the body.
Therefore, you need to get treatment for these plaques. If you are a smoker, you need to stop smoking, and control your high blood pressure and high cholesterol . These things can help prevent a heart attack or stroke in the future.
What specific treatments/surgeries are used for this?
You may need one or more of these methods:
- A surgery to create a bypass route by connecting the subclavian artery to another artery (for example, the carotid artery).
- Angioplasty and stenting - This involves widening the blocked area with something like a balloon and then inserting a mesh-like stent to prevent it from getting blocked again.
- Atherectomy - This means removing plaque from inside the artery.
- Endarterectomy - Removal of a portion of the inner lining of an artery.
Can complications occur from treatment?
Yes, the risks vary depending on the treatment. They may include:
- Your subclavian artery is narrowing again.
- Blood clots can form, which can even lead to a stroke.
- Damage to a nerve or blood vessel.
- Having some problems during healing.
How long does it take to recover after these treatments?
Recovery from treatment for subclavian steel syndrome can take a few days, a week, or even longer. Recovery from surgery is usually the longest.
What can I expect if I have subclavian steel syndrome?
More than 95% of people who undergo surgical treatment for subclavian steel syndrome never need to have another surgery. Their prognosis is generally good.
Is subclavian steal syndrome life-threatening?
No, this is not a life-threatening condition. However, it is a serious warning sign! It means that you have atherosclerosis, a disease of the arteries. When plaque builds up in your arteries, your heart or brain may not get enough oxygen in the future. This increases the risk of a heart attack or stroke.
Can subclavian steel syndrome be prevented?
We cannot control some of the causes of subclavian steel syndrome (such as genetic factors). However, the development of this syndrome can be largely prevented by preventing the plaque buildup (atherosclerosis), which is often the cause .
How can I reduce my risk?
You can reduce your risk of developing this condition – and therefore your risk of subclavian steel syndrome – by making these changes to your daily life:
- Maintain a healthy weight that suits you.
- Engage in physical activity (exercise) for at least 30 minutes a day on most days.
- Completely avoid the use of tobacco products (such as cigarettes and beedis).
- Eat heart-healthy foods (low in saturated fat and trans fat).
- If you have conditions like high cholesterol, high blood pressure, and diabetes, control them well.
How do I take care of myself?
If you have subclavian steel syndrome, it is important to take your medications as directed by your doctor, undergo any necessary surgery, and control high blood pressure, high cholesterol, and diabetes (if you have them) and avoid tobacco products.
When should I see my doctor?
After treatment, you should have regular checkups, especially if your symptoms return. If your doctor thinks your subclavian artery has narrowed again, he or she may order more imaging tests. You will need to have checkups at one month, six months, or a year after treatment. After that, you can see your doctor about once a year.
What questions should I ask my doctor?
It's a good idea to ask your doctor questions like these:
- How soon do I need treatment?
- What treatment method is best for me?
- What is your success rate in treating people with this condition?
So, what is the most important thing we need to remember from all of this?
Despite the word "Steal" in its name, subclavian steal syndrome is a treatable condition. Most people don't need treatment. But the biggest message we get from this is that plaque buildup (atherosclerosis) is happening in your arteries. Your body is telling you, "Start heart-healthy habits now, or improve the ones you already have." Ask your doctor about changes you can make to improve your health. Even small changes you can make today can have big results. So, let's not be afraid, be informed, and lay the foundation for a healthy life, shall we?
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