Subclavian Artery Stenosis

Patients may experience what is known as “subclavian steal syndrome” which is characterized as dizziness, vertigo, fainting, disorientation, or hearing loss. When the subclavian artery has narrowing closer to the start (origin) of the artery it can cause other vessels like the vertebral artery to reverse its own blood flow into the subclavian artery to help–this is called subclavian steal. Since the vertebral artery is meant to supply blood and oxygen to the back of our head and neck once it loses some of its circulation to the subclavian this may result in the above mentioned neurologic symptoms. 

When there is narrowing and plaque buildup in the subclavian artery closer to the vessels of the arm this can result in arm cramping, discomfort, numbness, and increasing fatigue in the upper extremity. Most patients do not experience the symptoms mentioned as these are very rare. Patients with narrowing and plaque buildup in the subclavian artery are usually asymptomatic.

Diagnostic tests include: 

Subclavian Ultrasound: This is a noninvasive, imaging study performed at our office that uses soundwaves to visualize the subclavian artery narrowing. We also check the blood pressure and PVR waveforms at three points in your upper extremity: the forearm, wrist, and fingers. This is a very commonly performed test which only takes about 15 minutes to complete.

Subclavian Angiogram: This is a minimally invasive procedure performed at our office in which a catheter is inserted in the arm or leg to inject contrast dye into the subclavian arteries. This test is often performed for patients with high grade subclavian narrowing to determine if they are a candidate for surgery. The procedure involves local sedation and takes less than an hour. 

Nonsurgical Treatment: 

For patients with mild blockages without notable symptoms, our physicians and team at BEVSA work with you to develop a treatment plan to prevent the progression of your disease.

Risk Factor Modification: Tobacco use damages the arterial walls which makes it easier for plaque to build up and cause complications such as “steal syndrome”. If you need help quitting smoking, our physicians will help you obtain information on medication, nicotine replacement products, and programs to make it easier

Diet and Activity: It is important to maintain a diet low in saturated fat, cholesterol, and sodium. Foods with these components can elevate cholesterol levels making it more likely for plaque to build up in the artery and cause narrowing. Our physicians will work with you to develop a customized, feasible, exercise plan and dieting.

Medication Management: Risk factors include elevated cholesterol/fat levels and type 2 diabetes. Statins have been shown to manage cholesterol/fat levels, stabilize plaque, and reduce the risk of plaque buildup. In addition patients with type 2 diabetes should engage in good glycemic control and work with their physician to achieve low levels of A1C. Our physicians will work with you to ensure you are on the proper medication regimen to lessen your risk of carotid disease and stroke development. 

Surgical Treatment 

Minimally Invasive Procedure: This is an angiogram procedure performed at our office that only involves a small incision in the wrist. A catheter (long, flexible tube) is then inserted in the arm to inject contrast dye into the arteries of the upper extremity. The dye and real time x-ray images are used to identify where blockages in the leg arteries are occurring. After the subclavian blockage is identified, the vascular surgeon may use angioplasty or stenting to improve the circulation. Angioplasty is when a small balloon is inflated inside of the vessel to widen it. A stent, which is a hollow, metal scaffold, is sometimes placed permanently inside the artery to hold it open. There are also drug eluting stents which release drugs that fight any further plaque buildup in the stent itself. Our BEVSA practice is one of the leaders in the region at safely and effectively performing these procedures outside of the hospital at our specialized outpatient procedure facility. The procedure takes about 1-2 hours and only requires local sedation. Patients are discharged home the same day as the procedure.

Surgical Bypass: This is an open surgical procedure performed at Buffalo General Hospital for patients that have full blockage of the artery that cannot be treated, or have failed to be treated, with a minimally invasive procedure. A bypass graft is placed to re-route the blood around the blocked portion of the artery and creates better circulation for the reduced portion of the vessel. This is a longer procedure that requires general anesthesia and medical clearance.