Upper extremity thromboembolism in a patient with subclavian steal syndrome

Subclavian steal is the physiologic process whereby blood flow through a vertebral artery is reversed at the level of the basilar artery as a means of supplying arterial inflow to the ipsilateral subclavian artery. This occurs in the setting of ipsilateral subclavian artery origin occlusion. We describe a case in which a patient with subclavian steal syndrome developed acute upper extremity ischemia secondary to thromboemboli from a chronically occluded ipsilateral subclavian stent (at the origin of the left subclavian artery). He subsequently underwent staged left upper extremity arterial thromboembolectomy followed by definitive revascularization via carotid-subclavian bypass. In addition, subclavian artery ligation proximal to the ipsilateral vertebral artery was performed. The patient's sensory and motor neurologic hand function returned to baseline with restoration of symmetric upper extremity arterial occlusion pressures and pulse volume recordings. A search of the literature revealed that this was the first case report of acute thromboembolic hand ischemia in the setting of subclavian steal.