Iatrogenic steal syndromes

Vascular steal syndromes result from many causes. Most often, however, they are due to arteriosclerotic occlusive disease and involve the innominate and the subclavian vessels. We have seen a number of patients with the steal syndrome and, in review, a number of unusual iatrogenic-induced steal syndromes. These included subclavian steal from the vertebral and circle of Willis, colonic and small bowel steal with subsequent ischemia, hand and arm steal syndrome in AV access for dialysis. Multiple symptomatology including dizziness, headache, bloody diarrhea, paraplegia, pain and coma were all present. The diagnosis requires realization of the possibility and angiography where necessary. Intensive therapy and possible further surgical intervention can lead to survival and good function. However, a significant percentage of patients may end up with paraplegia or death. Thus, recognition and intervention (where appropriate) are important to minimize the severity of the problem.