title: A forgotten vascular disease with important clinical implications. Subclavian steal syndrome.
abstract: BACKGROUND
  Subclavian Steal Syndrome (SSS) is a fascinating vascular phenomenon in which a steno-occlusive lesion of the proximal subclavian artery causes retrograde flow in the vertebral artery away from the brain stem subsequently causing vertebrobasilar insufficiency. SSS can present with a myriad of neurological and vascular signs and symptoms, but most commonly this phenomenon presents as an incidental finding in an asymptomatic patient.
  
  
  METHODS
  Our patient is a 73-year-old female sent to the cardiology clinic for surgical clearance in preparation for an elective cholecystectomy. Shortness of breath was her only complaint. Review of systems was remarkable for left arm pain and blurry vision with repetitive movement. Physical examination noticeable for absence of left radial pulse. Percutaneous angiography demonstrated a totally occulted left subclavian artery with collateral circulation form the vertebrobasilar apparatus.
  
  
  CONCLUSIONS
  Atypical presentation of this unique entity represents a challenge for physicians who require a high index of suspicion to make the diagnosis. We present an atypical case with radiographical evidence of the steal syndrome, followed by an extensive literature review of the most current diagnostic methods as well as latest recommendations for treatment options and secondary prevention.
authors.affiliation: Providence Heart Institute, Providence Hospital and Medical Center, Wayne State University School of Medicine, Southfield, MI, U.S.A.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alcocer
authors.forename: Mariam
authors.initials: M
authors.lastname: David
authors.forename: Rachel
authors.initials: R
authors.lastname: Goodman
authors.forename: Sachin Kumar Amruthlal
authors.initials: SK
authors.lastname: Jain
authors.forename: Shukri
authors.initials: S
authors.lastname: David
keywords: subclavian steal syndrome; subclavian-steal-syndrome