Subclavian steal "syndromes" [Le »sindromi« da furto della succlavia]

In 1959 Contorni described the "sindrome da emoderivazione cefalo-brachlale", characterized by vertebral flow inversion omolaterally to a proximal subclavian artery's occlusion; the definition "subclavian steal syndrome" was done by Reivich in 1961. The vascular steal happens consequently of a pre-vertebral subclavian stenosis-occlusion: more often the nature of lesion is atherosclerotic, but is possible an inflammatory, displastic or iatrogenic etiology. The prevalence in general population is 1,9%: lesions determining a steal represent the 1,5-3% of all arteriopaties. Risk factors associated are smoke, hypertension, diabetes, cerebrovascular and coronary disease, and peripheral arterial disease. Especially in conditions of increased metabolic request of upper limb may happens a blood distrainment of other districts, typically cerebral one through the inversion of vertebral flow, with neurological symptomatology. Moreover is possible a compensation to upper limb from other collateral circles: clinical importance of a steal such as the mammary-subclavian one is interesting in case of coronary bypass realized with internal mammary artery, because happens a coronary steal with ischemic symptomatology. Very frequently steal is asymptomatic. Besides classical vertebral-subclavian steal (permanent, intermittent, latent) is described the carotid-subclavian steal and the rarest coronary-subclavian steal. Is also described an aortic arch syndrome characterized by contemporary compromission of all supra-aortic trunks. It seems more correct talking about "syndromes" of subclavian steal. Angiography represented the diagnostic gold standard in prevision of operation; echo-color-Doppler, sensitized by compression test and reactive hyperemia test, can supply important anatomic and functional informations, but, at the moment, best informations are supplied by angio-TC and angio-RM.